Provider Demographics
NPI:1043214588
Name:GLEASON, MICHELE L (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:611 N DIERS AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4960
Mailing Address - Country:US
Mailing Address - Phone:308-381-4733
Mailing Address - Fax:308-381-6462
Practice Address - Street 1:611 N DIERS AVE
Practice Address - Street 2:STE 2
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4960
Practice Address - Country:US
Practice Address - Phone:308-381-4733
Practice Address - Fax:308-381-6462
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE19617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082399313Medicaid
NEG50615Medicare UPIN
NE47082399313Medicaid