Individual
JEFFREY B GLEICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1989 MIAMISBURG CENTERVILLE RD, SUITE 301, CENTERVILLE, OH 45459-3859
(937) 434-7353
(937) 438-6569
Mailing address
2912 SPRINGBORO RD, SUITE 201, MORAINE, OH 45439-1674
(937) 297-8999
(937) 298-9673
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-067476
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2065125
—
OH
01
—
GL4038173
PTAN
—
01
—
P00708877
RAILROAD MEDICARE
OH
Enumeration date
06/17/2005
Last updated
03/23/2016
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