Healthcare Provider Details

I. General information

NPI: 1750481552
Provider Name (Legal Business Name): JOSEPH MATTHEW GLUSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15209 W MICHIGAN AVE
MARSHALL MI
49068-9570
US

IV. Provider business mailing address

15209 W MICHIGAN AVE
MARSHALL MI
49068-9570
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-9119
  • Fax: 269-781-7872
Mailing address:
  • Phone: 269-781-9119
  • Fax: 269-781-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301407615
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: