Organization
GLENDA M GENSOLIN MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENDA M GENSOLIN MD (PRESIDENT)
(269) 683-0330
Entity
Organization
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
261QP2300X
Primary Care Clinic/Center
Primary
4301090975
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033195748
NPI
—
Enumeration date
09/04/2007
Last updated
03/10/2014
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