Organization
GLENNAN MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHERYL WISSMAN MD (OWNER/PHYSICIAN)
(248) 628-2233
Entity
Organization
Contact information
Practice address
72 S WASHINGTON ST, SUITE 204, OXFORD, MI 48371-6421
(248) 628-2233
(248) 628-2384
Mailing address
72 S WASHINGTON ST, SUITE 204, OXFORD, MI 48371-6421
(248) 628-2233
(248) 628-2384
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301051927
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1011749
HEALTH ADVANTAGE
MI
01
—
110F302700
BCBS
MI
01
—
125218
PREFERRED CHOICES
MI
01
—
4266551
AETNA
MI
05
—
4406452
—
MI
05
—
4603282
—
MI
01
—
7023567
AETNA
MI
01
—
CF9338
RAILROAD MEDICARE
MI
01
—
E49479
HAP
MI
01
—
I17832
HAP
MI
Enumeration date
07/12/2005
Last updated
04/22/2020
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