Provider Demographics
NPI:1447215728
Name:WOOD, MICHAEL GLENN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GLENN
Last Name:WOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3545 LINCOLN WAY E
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8624
Mailing Address - Country:US
Mailing Address - Phone:330-837-5191
Mailing Address - Fax:330-837-0755
Practice Address - Street 1:3545 LINCOLN WAY E
Practice Address - Street 2:SUITE A
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8624
Practice Address - Country:US
Practice Address - Phone:330-837-5191
Practice Address - Fax:330-837-0755
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-114780207W00000X
OH34.009396207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2861103Medicaid
OHP00680882OtherRR MEDICARE
OH000000577625OtherANTHEM
OH0439750002Medicare NSC
OH4245781Medicare PIN
OH000000577625OtherANTHEM
OH0439750001Medicare NSC
ILI 54368Medicare UPIN