Individual
GLENN TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
26850 PROVIDENCE PKWY, SUITE 370, NOVI, MI 48374-1213
(248) 465-4160
(248) 465-4525
Mailing address
26850 PROVIDENCE PKWY, SUITE 370, NOVI, MI 48374-1213
(248) 465-4160
(248) 465-5425
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301407458
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305718810
—
MI
01
—
4301407458
CONTROLLED SUBSTANCE
MI
01
—
BT1304841
CONTROLLED SUBSTANCE
—
Enumeration date
08/10/2005
Last updated
05/21/2014
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