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General NPI Number Information
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NPI Number | 1093663023
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Entity Type | Organization
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Legal Business Name | GLEGEN MEDICAL PLLC
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 5165 NORTHLAND DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1015
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Country | US
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Telephone | 877-340-1697
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Fax |
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Provider Business Mailing Address
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Address Line | 5165 NORTHLAND DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1015
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | DR. GLEB GENDEL
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Credential | DO
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Telephone | 877-340-1697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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