Provider Demographics
NPI:1235467036
Name:PAUL V. GLOWACKI MD LLC
Entity type:Organization
Organization Name:PAUL V. GLOWACKI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:GLOWACKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-721-5727
Mailing Address - Street 1:350 W 23RD ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2592
Mailing Address - Country:US
Mailing Address - Phone:402-721-5727
Mailing Address - Fax:402-753-6096
Practice Address - Street 1:350 W 23RD ST
Practice Address - Street 2:SUITE G
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2592
Practice Address - Country:US
Practice Address - Phone:402-721-5727
Practice Address - Fax:402-721-6096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========OtherTAX I.D