Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301056116 | MI |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 4301056116 | MI |
NPI | 1104897958 |
---|---|
Provider Name | Dr. Glenn J Minster |
First Address | Wyandotte, MI 48192-4080 |
Second Address | Wyandotte, MI 48192-4080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 02/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103279963 | (05) | MI |
F87869 | (02) | MI |