Individual
MITCHELL LYLE GLASER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD.
Contact information
Practice address
1101 W ADAMS ST, #B, CHICAGO, IL 60607-2903
(312) 770-3512
(312) 770-3345
Mailing address
PO BOX 1394, LA GRANGE PARK, IL 60526-9494
(312) 491-5498
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036053454
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053454
—
IL
Enumeration date
07/26/2006
Last updated
05/30/2024
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