Provider Demographics
NPI:1154521177
Name:GLASS, LISA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:GLASS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5300 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8632
Mailing Address - Country:US
Mailing Address - Phone:734-822-2826
Mailing Address - Fax:734-434-9517
Practice Address - Street 1:5300 ELLIOTT DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8632
Practice Address - Country:US
Practice Address - Phone:734-434-6262
Practice Address - Fax:744-712-2820
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2023-09-27
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Provider Licenses
StateLicense IDTaxonomies
MI4301090095207RG0100X, 207RG0100X
NHRT 2261207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology