Provider Demographics
NPI:1447389044
Name:GLIHA, GREGORY L (PA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:L
Last Name:GLIHA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:GLIHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:251 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1001
Mailing Address - Country:US
Mailing Address - Phone:734-454-1037
Mailing Address - Fax:734-397-2892
Practice Address - Street 1:34815 W MICHIGAN AVE
Practice Address - Street 2:STE A
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1799
Practice Address - Country:US
Practice Address - Phone:734-389-7103
Practice Address - Fax:734-389-7103
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001483363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601001483OtherPA LICENSE NUMBER