Provider Demographics
NPI:1083707004
Name:TOKARSKI, GLENN F (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:F
Last Name:TOKARSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36475 5 MILE RD.
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-655-1420
Mailing Address - Fax:734-655-1445
Practice Address - Street 1:36475 5 MILE RD.
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-655-1420
Practice Address - Fax:734-655-1445
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047890207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4333024Medicaid
MI4333024Medicaid