Provider Demographics
NPI:1275567828
Name:GLEESPEN, MARTIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:P
Last Name:GLEESPEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1290 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1454
Mailing Address - Country:US
Mailing Address - Phone:734-475-1107
Mailing Address - Fax:734-475-9230
Practice Address - Street 1:1290 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1454
Practice Address - Country:US
Practice Address - Phone:734-475-1107
Practice Address - Fax:734-475-9230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIMG048067207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3253813 TYPE 10Medicaid
MIA73223Medicare UPIN