Healthcare Provider Details

I. General information

NPI: 1659448751
Provider Name (Legal Business Name): JAMES J GLAZIER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R SUITE 525
DETROIT MI
48201
US

IV. Provider business mailing address

4160 JOHN R SUITE 525
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-1100
  • Fax: 313-831-1177
Mailing address:
  • Phone: 313-831-1100
  • Fax: 313-831-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES J GLAZIER
Title or Position: SOLE BUSINESS OWNER
Credential: MD
Phone: 313-831-1988