Individual
DR. GLENN A GRADIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3950 S ROCHESTER RD, SUITE 1200, ROCHESTER HILLS, MI 48307-5160
(248) 844-6000
(248) 844-6159
Mailing address
3950 S ROCHESTER RD, SUITE 1200, ROCHESTER HILLS, MI 48307-5160
(248) 844-6000
(248) 844-6159
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101006988
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679543292
—
MI
01
—
700H273300
BLUE SHIELD GROUP
MI
Enumeration date
01/25/2006
Last updated
12/06/2013
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