Healthcare Provider Details

I. General information

NPI: 1346280260
Provider Name (Legal Business Name): JAMES JOSEPH GLAZIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 JOHN R #525
DETROIT MI
48201
US

IV. Provider business mailing address

4160 JOHN R #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 TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301068259
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301068259
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: