Provider Demographics
NPI:1982223921
Name:GLUCK, CHRISTIAN BARRETT
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:BARRETT
Last Name:GLUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 GRIDER STREET
Mailing Address - Street 2:DK MILLER BLDG, 3RD FLOOR
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-898-6515
Mailing Address - Fax:716-898-5029
Practice Address - Street 1:462 GRIDER STREET
Practice Address - Street 2:DK MILLER BLDG, 3RD FLOOR
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-6515
Practice Address - Fax:716-898-5029
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program