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NPI Code Detail

MEDICARE: EDGAR GLOVER

MEDICARE: EDGAR GLOVER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1093118135
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDGAR GLOVER
Provider Business Mailing Address
First Line : 24424 W MCNICHOLS RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-3653
Country : US
Telephone Number : 313-255-0900
Fax Number :
Provider Business Practice Location Address
First Line : 24424 W MCNICHOLS RD
Second Line :
City : DETROIT
State : MI
Zip : 48219-3653
Country : US
Telephone Number : 313-255-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2014
Last Update Date : 01/25/2026

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Directions to “ EDGAR GLOVER ” Practice Location

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