Great Lakes Regenerative Medicine, PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

GREAT LAKES REGENERATIVE MEDICINE, PLLC

Practice address

2251 N Squirrel Rd Ste 206
Auburn Hills, MI 48326-4602

Phone

(248) 829-0385

NPI assigned

Jan 3, 2020

Last updated

Feb 27, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert J Basak, DO

Title

Clinic Director

Phone

(248) 829-0385

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Erin Rae Arnold, D.C

  • Rehabilitation Chiropractor
  • Acworth, GA
  • NPI 1669709267
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1033758305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 GOLF CREST DR",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301015968",
            "telephone_number": "248-829-0239",
            "fax_number": "678-574-5605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 N SQUIRREL RD STE 206",
            "city": "AUBURN HILLS",
            "state": "MI",
            "postal_code": "483264602",
            "telephone_number": "248-829-0385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES REGENERATIVE MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-03",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A",
        "authorized_official_last_name": "BASAK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "248-829-0385",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace T Gottman
• Vasilia Patricia Graboski, MS,LLP
• Elizabeth Jane Grahn, LMSW
• Kenneth Vernon Grattan, OD
• Great Lakes Comprehensive Care, LLC
• Great Lakes Vitality, LLC (Vital Care of Auburn Hills)
• Gregory M Okoniewski PLLC
• Kristyn Marie Gregory, D.O.
• Candace Griffey
• Joshua Douglas Griffin

• Clinic/Center in Auburn Hills, MI
• Providers in Auburn Hills, MI by specialty
• Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.