Provider Demographics
NPI:1770637670
Name:SAPERSTEIN, GLENN (DO)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:SAPERSTEIN
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 1:5889 BAY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2540
Mailing Address - Country:US
Mailing Address - Phone:989-791-7999
Mailing Address - Fax:989-791-7996
Practice Address - Street 1:5889 BAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2540
Practice Address - Country:US
Practice Address - Phone:989-791-7999
Practice Address - Fax:989-791-7996
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011716208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG23899Medicare UPIN