Provider Demographics
NPI:1336723816
Name:GLOVER, MARK ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:GLOVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:44405 WOODWARD AVE # H-23
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5023
Mailing Address - Country:US
Mailing Address - Phone:248-858-3234
Mailing Address - Fax:248-858-3242
Practice Address - Street 1:44405 WOODWARD AVE # H-23
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5151015028208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery