Active NPI
Ted Gloster Jr.
- Contractor
- Detroit, MI
National Provider Identifier
1043919558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- G423789004993
- Practice address
- 2436 Hazelwood St
Detroit, MI 48206-2244 - Phone
- (313) 346-3761
- NPI assigned
- Feb 23, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | G423789004993 | MI | Primary |
Addresses
Primary practice location
2436 Hazelwood St
Detroit, MI 48206-2244
Mailing address
2436 Hazelwood St
Detroit, MI 48206-2244
Phone (313) 346-3761
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G423789004993 | MI | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677110400000",
"number": "1043919558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2436 HAZELWOOD ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482062244",
"telephone_number": "313-346-3761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2436 HAZELWOOD ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482062244",
"telephone_number": "313-346-3761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLOSTER",
"first_name": "TED",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-02-23",
"last_updated": "2023-02-23",
"certification_date": "2023-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "MI",
"license": "G423789004993",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.