Healthcare Provider Details

I. General information

NPI: 1134128093
Provider Name (Legal Business Name): GLENN V DREGANSKY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 11/27/2023
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OAKLAND DRIVE
KALAMAZOO MI
49008
US

IV. Provider business mailing address

1000 OAKLAND DRIVE
KALAMAZOO MI
49008
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34006599
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101010072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: