Individual
GLENN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7409 WOODRIDGE DR, WOODRIDGE, IL 60517-2249
(630) 241-1000
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036065152
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065152
—
IL
Enumeration date
03/08/2006
Last updated
08/16/2023
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