Organization
VANGUARD CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOSEPH GLICKERT (OWNER)
(314) 567-7300
Entity
Organization
Contact information
Practice address
2108 SCHUETZ RD, SAINT LOUIS, MO 63146-3538
(314) 567-7300
Mailing address
2108 SCHUETZ RD, SAINT LOUIS, MO 63146-3538
(314) 567-7300
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2013042448
MO
Other
Enumeration date
01/03/2018
Last updated
04/09/2018
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