Healthcare Provider Details

I. General information

NPI: 1982630612
Provider Name (Legal Business Name): CYNTHIA L GLASSON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 S BALDWIN RD
ORION MI
48359-2358
US

IV. Provider business mailing address

3003 S BALDWIN RD
ORION MI
48359-2358
US

V. Phone/Fax

Practice location:
  • Phone: 248-391-9090
  • Fax: 248-391-9210
Mailing address:
  • Phone: 248-391-9090
  • Fax: 248-391-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberCG011459
License Number StateMI

VIII. Authorized Official

Name: DR. CYNTHIA L GLASSON
Title or Position: OWNER
Credential: D.O.
Phone: 248-391-9090