NPIMap

Organization Active NPI

Great Lakes Podiatry PLLC

  • Durable Medical Equipment & Medical Supplies
  • Escanaba, MI
National Provider Identifier
1043728553
Registry record updated Mar 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
5901001228 Issued in MI
Legal business name
GREAT LAKES PODIATRY PLLC
Practice address
126 S 25TH St Ste a
Escanaba, MI 49829-1364
Phone
(906) 786-2385
Fax
(877) 276-3960
NPI assigned
Jan 18, 2018
Last updated
Mar 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

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

Authorized official

Name
Dennis W Leveille, DPMNPI 1982696209
Title
Owner/Podiatrist
Phone
(906) 786-2385

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 5901001228 MI Primary
Prosthetic/Orthotic Supplier 335E00000X 5901001228 MI

Addresses

Primary practice location

126 S 25TH St Ste a
Escanaba, MI 49829-1364

Mailing address

W4042 Lake Mary Dr S
Vulcan, MI 49892-8452
Phone (906) 280-5396

Other identifiers 2

IdentifierTypeStateIssuer
1982696209MedicaidMI
1225079932MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Podiatry PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

126 S 25th St
Ste A
Escanaba, MI 49829
Phone (906) 786-2385

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773273600000",
    "number": "1043728553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W4042 LAKE MARY DR S",
            "city": "VULCAN",
            "state": "MI",
            "postal_code": "498928452",
            "telephone_number": "906-280-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 S 25TH ST STE A",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291364",
            "telephone_number": "906-786-2385",
            "fax_number": "877-276-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PODIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A",
        "authorized_official_last_name": "LEVEILLE",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/PODIATRIST",
        "authorized_official_telephone_number": "906-786-2385",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5901001228",
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MI",
            "license": "5901001228",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982696209",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225079932",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Escanaba, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2026; 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.