Provider Demographics
NPI:1982630612
Name:CYNTHIA L GLASSON INC
Entity Type:Organization
Organization Name:CYNTHIA L GLASSON INC
Other - Org Name:WALDON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLASSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-391-9090
Mailing Address - Street 1:3003 S BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2358
Mailing Address - Country:US
Mailing Address - Phone:248-391-9090
Mailing Address - Fax:248-391-9210
Practice Address - Street 1:3003 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2358
Practice Address - Country:US
Practice Address - Phone:248-391-9090
Practice Address - Fax:248-391-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICG011459261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F32366OtherBLUE CROSS BLUE SHIELD
MI0F32366OtherBLUE CARE NETWORK
MI3364670Medicaid
MIF43394OtherHAP
MI01000827OtherHEALTH PLUS OF MICHIGAN
MI1982630612Medicaid
MI4294873OtherAETNA
MI01000827OtherHEALTH PLUS OF MICHIGAN
MI3364670Medicaid
MIF43394Medicare UPIN
MI1982630612Medicaid