Glenwood Medical Corporation LTD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036059084 Issued in IL

Legal business name

GLENWOOD MEDICAL CORPORATION LTD

Practice address

10735 W 159TH Street
Orland Park, IL 60467

Phone

(708) 873-7775

Fax

(708) 873-0192

NPI assigned

Jun 7, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James B Bray, MD

Title

Physician President of Corporation

Phone

(708) 873-7775

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312848000000",
    "number": "1912947888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10735 W 159TH STREET",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "60467",
            "telephone_number": "708-873-7775",
            "fax_number": "708-873-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10735 W 159TH STREET",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "60467",
            "telephone_number": "708-873-7775",
            "fax_number": "708-873-0192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENWOOD MEDICAL CORPORATION LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2011-08-09",
        "status": "A",
        "authorized_official_last_name": "BRAY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PHYSICIAN PRESIDENT OF CORPORATION",
        "authorized_official_telephone_number": "708-873-7775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036059084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036059084",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.