| Organization Name: | SOUTHEAST MICHIGAN MEDICAL GROUP PC |
| NPI Number: | 1205087855 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GLENN V DREGANSKY (SOLE PROPRIETOR) |
| Mailing Address: | 39000 Chase St Romulus |
| State: | MI US |
| Postal Code: | 481741303 |
| Phone Number: | 7349411260 |
| Fax Number: | 7349415650 |
| NPI Enumeration Date: | 10/01/2008 |
| NPI Last Update Date: | 10/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101010072 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |