Healthcare Provider Details

I. General information

NPI: 1003819400
Provider Name (Legal Business Name): GLENN E MERZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 LEAHY ST STE 301
MUSKEGON MI
49442-5543
US

IV. Provider business mailing address

PO BOX 1848
MUSKEGON MI
49443-1848
US

V. Phone/Fax

Practice location:
  • Phone: 231-728-5007
  • Fax: 231-728-5014
Mailing address:
  • Phone: 231-727-4444
  • Fax: 231-727-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGM054275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: