Individual
MR. GLEN DWAYNE GERDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
801 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3204
(847) 990-5779
Mailing address
630 TALLGRASS LN, LAKE VILLA, IL 60046-6632
(847) 265-4113
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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