Provider Demographics
NPI:1497757504
Name:SWARTZLANDER, GLENN C (DO)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:C
Last Name:SWARTZLANDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18690 PINECREST LN
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1175
Mailing Address - Country:US
Mailing Address - Phone:616-846-5947
Mailing Address - Fax:
Practice Address - Street 1:3535 PARK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:231-737-0411
Practice Address - Fax:231-739-8502
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006218208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2812050Medicaid
MIF04794Medicare UPIN