MEDICARE: GLEN NEIL ACKERMAN M.D.

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	2084N0400X	Neurology Physician	4301046992	MI

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912060633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLEN NEIL ACKERMAN M.D.

Provider Business Mailing Address
First Line	:	804 SERVICE RD RM A217
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48824-7015
Country	:	US
Telephone Number	:	517-353-8122
Fax Number	:	517-432-3713

Provider Business Practice Location Address
First Line	:	804 SERVICE RD
Second Line	:	ROOM A217
City	:	EAST LANSING
State	:	MI
Zip	:	48824-1376
Country	:	US
Telephone Number	:	517-353-8122
Fax Number	:	517-432-3713

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	02/10/2026

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