=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740469451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEONARD T GLINSKI DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2007
-----------------------------------------------------
Last Update Date | 03/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6255 INKSTER RD SUITE 202
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48135-2577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-261-8040
-----------------------------------------------------
Fax | 734-261-8085
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6255 INKSTER RD SUITE 202
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48135-2577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-261-8040
-----------------------------------------------------
Fax | 734-261-8085
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LEONARD T GLINSKI
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 734-261-8040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | 51005767
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------