Individual
LIONEL GLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
43494 WOODWARD AVENUE, SUITE 103, BLOOMFIELD HILLS, MI 48302-0567
(866) 485-1399
(206) 333-0668
Mailing address
1976 S LA CIENEGA BLVD, # 255, LOS ANGELES, CA 90034-1627
(866) 485-1399
(206) 333-0668
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
4301031094
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103504593
—
MI
01
—
130635749
BCBS
MI
01
—
27-2558278
TAX ID
MI
Enumeration date
09/13/2006
Last updated
06/23/2010
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