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DR. GLENN LEROY BYNUM M.D.

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1366581175

Individual Registrant:
DR. GLENN LEROY BYNUM M.D.
Gender: M
Sole Proprietor

Location and contact information for practice:
902 MONROE AVE  RIVER FOREST, IL 60305-1424 US
Tel: 708-771-4588  Fax: --

Contact information for business:
902 MONROE AVE  RIVER FOREST, IL 60305-1424 US
Tel: 708-771-4588  Fax: --

Registration Information:
NPI: 1366581175
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
IL

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
DEAAB8656538IL01




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