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NPI Code Detail

MEDICARE: SIMON MALCOLM GLYNN MD

MEDICARE: SIMON MALCOLM GLYNN MD
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
12084N0400XNeurology Physician4301093239MI
22084N0400XNeurology PhysicianMD427264PA
32084N0600XClinical Neurophysiology Physician4301093239MI
42084E0001XEpilepsy Physician4301093239MI

General Provider Information

NPI Number : 1124173026
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMON MALCOLM GLYNN MD
Provider Business Mailing Address
First Line : 3621 S STATE ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48108-1633
Country : US
Telephone Number : 734-647-5299
Fax Number :
Provider Business Practice Location Address
First Line : 1500 E MEDICAL CENTER DR
Second Line :
City : ANN ARBOR
State : MI
Zip : 48109-5000
Country : US
Telephone Number : 734-936-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 12/30/2024

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