Individual
MICHAEL GLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
35903
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215713000
—
WV
01
—
2794
PARTNERS
—
01
—
35991
BCBS
—
01
—
44931
MEDCOST
—
01
—
4525084
AETNA
—
05
—
6710026
—
VA
05
—
8935991
—
NC
05
—
Q35903
—
SC
Enumeration date
12/13/2005
Last updated
05/08/2008
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