Individual
GLEN ANTOINE REID JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19853 OUTER DR, DEARBORN, MI 48124-2066
(313) 406-5056
Mailing address
19853 OUTER DR, DEARBORN, MI 48124-2066
(347) 526-6915
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W231852855
AETNA
NY
Enumeration date
06/08/2021
Last updated
06/14/2021
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