Individual
DR. JONATHAN SHANE GLICKSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 N MELVIN ST, GIBSON CITY, IL 60936-1477
(217) 784-2212
Mailing address
1120 N MELVIN ST, GIBSON CITY, IL 60936-1477
(217) 784-2212
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036.154865
IL
207Y00000X
Otolaryngology Physician
49523
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
886103000
—
MN
Enumeration date
04/24/2007
Last updated
03/22/2021
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