Provider Demographics
NPI:1740469451
Name:LEONARD T GLINSKI DO PC
Entity type:Organization
Organization Name:LEONARD T GLINSKI DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:GLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-261-8040
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-261-8040
Mailing Address - Fax:734-261-8085
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-261-8040
Practice Address - Fax:734-261-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51005767207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0458216344OtherBLUE CROSS BLUE SHIELD MI
MI0458216354OtherBLUE CROSS BLUE SHIELD MI
MIE37250Medicare UPIN
MIE68169Medicare UPIN
MI0P49960Medicare PIN
MI0458216344OtherBLUE CROSS BLUE SHIELD MI
MIP49960002Medicare PIN