Provider Demographics
NPI:1184045296
Name:GLENN SAPERSTEIN LLC
Entity Type:Organization
Organization Name:GLENN SAPERSTEIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAPERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-894-0184
Mailing Address - Street 1:5889 BAY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2540
Mailing Address - Country:US
Mailing Address - Phone:989-791-7999
Mailing Address - Fax:989-791-7996
Practice Address - Street 1:5889 BAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2540
Practice Address - Country:US
Practice Address - Phone:989-791-7999
Practice Address - Fax:989-791-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011716208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG23899Medicare UPIN