Individual
MICHAEL J GLIME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6777
Mailing address
PO BOX 735041, CHICAGO, IL 60673-5041
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4177
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100074278
—
WI
Enumeration date
08/28/2017
Last updated
02/06/2024
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