# DR. MICHAEL GLENN DOMINA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1396130613
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 1630 | NE | — |
| 207V00000X | Obstetrics & Gynecology Physician | 5095 | TN | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | DO213625 | OR | — |
| 207V00000X | Obstetrics & Gynecology Physician | DO3503 | ME | — |
| 207V00000X | Obstetrics & Gynecology Physician | LT22012 | ME | — |

## Other

- **Enumeration date:** 04/02/2015
- **Last updated:** 12/20/2024