Provider Demographics
NPI:1659448751
Name:JAMES J GLAZIER MD PC
Entity Type:Organization
Organization Name:JAMES J GLAZIER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-831-1988
Mailing Address - Street 1:4160 JOHN R
Mailing Address - Street 2:SUITE 525
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-831-1100
Mailing Address - Fax:313-831-1177
Practice Address - Street 1:4160 JOHN R
Practice Address - Street 2:SUITE 525
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-831-1100
Practice Address - Fax:313-831-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4180391Medicaid
F39073Medicare UPIN
MI4180391Medicaid