Individual
DR. GLEN L RICCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
109 E ELM ST, STREATOR, IL 61364-2223
(815) 672-4587
(815) 673-3582
Mailing address
109 E ELM ST, STREATOR, IL 61364-2223
(815) 672-4587
(815) 673-3582
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036060768
IL
Other
Enumeration date
05/24/2006
Last updated
03/10/2011
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