Individual
GLENDA M GENSOLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
24 N SAINT JOSEPH AVE STE C2, NILES, MI 49120-2263
(269) 683-0330
(269) 684-0400
Mailing address
24 N SAINT JOSEPH AVE STE C2, NILES, MI 49120-2263
(269) 683-0330
(269) 684-0400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
35068802G
OH
207Q00000X
Family Medicine Physician
Primary
4301090975
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437343373
GROUP NPI
MI
Enumeration date
12/15/2005
Last updated
03/10/2014
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