MEDICARE: DR. MICHAEL GLENN WOOD D.O.

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
1	207W00000X	Ophthalmology Physician	036-114780	IL
2	207W00000X	Ophthalmology Physician	34.009396	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00680882	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000577625	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1447215728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GLENN WOOD D.O.

Provider Business Mailing Address
First Line	:	3545 LINCOLN WAY E
Second Line	:	SUITE A
City	:	MASSILLON
State	:	OH
Zip	:	44646-8624
Country	:	US
Telephone Number	:	330-837-5191
Fax Number	:	330-837-0755

Provider Business Practice Location Address
First Line	:	3545 LINCOLN WAY E
Second Line	:	SUITE A
City	:	MASSILLON
State	:	OH
Zip	:	44646-8624
Country	:	US
Telephone Number	:	330-837-5191
Fax Number	:	330-837-0755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	06/27/2012

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Directions to “ DR. MICHAEL GLENN WOOD D.O.” Practice Location

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