Individual
GLENN E GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
4301057683
MI
207YP0228X
Pediatric Otolaryngology Physician
Primary
4301057683
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4569350
—
MI
Enumeration date
10/06/2006
Last updated
11/25/2019
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