Provider Demographics
NPI:1174619993
Name:GLEVECKAS-MARTENS, NIDA (DO)
Entity type:Individual
Prefix:DR
First Name:NIDA
Middle Name:
Last Name:GLEVECKAS-MARTENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1105
Mailing Address - Country:US
Mailing Address - Phone:708-227-7884
Mailing Address - Fax:
Practice Address - Street 1:821 SOUTH DAMEN
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY 9TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-569-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology