Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301105382 | MI |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 4301105382 | MI |
NPI | 1114330339 |
---|---|
Provider Name | Alexander Glaros |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2014 |
Last Update Date | 04/09/2020 |