Individual
MS. MELISSA LYNN GLAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
320 EMERALD CT S, WHITMORE LAKE, MI 48189-8267
(734) 408-1781
Mailing address
320 EMERALD CT S, WHITMORE LAKE, MI 48189-8267
(734) 408-1781
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
G420599564562
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VS0332043
MHHDS SIGMA VSS
MI
Enumeration date
10/03/2024
Last updated
10/03/2024
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