MEDICARE: MR. GREGORY L. GLIHA PA

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	363AM0700X	Medical Physician Assistant	5601001483	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5601001483	OTHER	MI	PA LICENSE NUMBER

General Provider Information

NPI Number	:	1447389044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY L. GLIHA PA

Provider Business Mailing Address
First Line	:	251 AUBURN ST
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-1001
Country	:	US
Telephone Number	:	734-454-1037
Fax Number	:	734-397-2892

Provider Business Practice Location Address
First Line	:	34815 W MICHIGAN AVE
Second Line	:	STE A
City	:	WAYNE
State	:	MI
Zip	:	48184-1799
Country	:	US
Telephone Number	:	734-389-7103
Fax Number	:	734-389-7103

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	11/17/2016

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