Provider Demographics
NPI:1760571004
Name:GLOVER, FRANK (DO)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:GLOVER
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 1:8500 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2425
Mailing Address - Country:US
Mailing Address - Phone:313-894-3950
Mailing Address - Fax:313-894-1729
Practice Address - Street 1:5050 JOY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2263
Practice Address - Country:US
Practice Address - Phone:313-894-4004
Practice Address - Fax:313-894-1729
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFG005662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4361619Medicaid
E25854Medicare UPIN
MI4361619Medicaid