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Individual

DR. LISA M GLOSSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
3707 DOTY RD STE G, WOODSTOCK, IL 60098
(815) 338-6600
(815) 338-9488
Mailing address
3707 DOTY RD STE G, WOODSTOCK, IL 60098-7530
(815) 338-6600
(815) 338-9488

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036097016
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
036097016
STATE LICENSE
IL
01
P00012141
MEDICARE RAILROAD
IL
Enumeration date
05/02/2006
Last updated
10/19/2018
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