Provider Demographics
NPI:1992805857
Name:GLADKA, GALINA
Entity type:Individual
Prefix:DR
First Name:GALINA
Middle Name:
Last Name:GLADKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-790-0070
Mailing Address - Fax:989-249-0449
Practice Address - Street 1:125 N COLONY DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7101
Practice Address - Country:US
Practice Address - Phone:989-790-0070
Practice Address - Fax:989-249-0449
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGG072192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4467959Medicaid
MI4467959Medicaid
MIC26008090Medicare ID - Type Unspecified