Provider Demographics
NPI:1760422158
Name:GLAZER, LOUIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:C
Last Name:GLAZER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2505 E PARIS AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2459
Mailing Address - Country:US
Mailing Address - Phone:616-285-1200
Mailing Address - Fax:616-940-0864
Practice Address - Street 1:2505 E PARIS AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2459
Practice Address - Country:US
Practice Address - Phone:616-285-1200
Practice Address - Fax:616-940-0864
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301057485207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3234685Medicaid
MIF31248Medicare UPIN
MI0M23610Medicare ID - Type Unspecified