Great Lakes Radiology PLLC

Primary specialty

Radiography Radiologic TechnologistTaxonomy code 2471C3402X

License

4301067927 Issued in MI

Legal business name

GREAT LAKES RADIOLOGY PLLC

Practice address

461 West Huron
Pontiac, MI 48341

Phone

(248) 857-7200

NPI assigned

Jun 30, 2015

Last updated

Jun 30, 2015By 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

Venicat Rudraraju, MD

Title

Owner

Phone

(248) 884-0003

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1154704948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 DOW RIDGE RD",
            "city": "ORCHARD LAKE",
            "state": "MI",
            "postal_code": "483242326",
            "telephone_number": "248-884-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 WEST HURON",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "48341",
            "telephone_number": "248-857-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES RADIOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-30",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "RUDRARAJU",
        "authorized_official_first_name": "VENICAT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-884-0003",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2471C3402X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Radiography",
            "state": "MI",
            "license": "4301067927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Grappin, LMSW
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• Greater Lakes Transportation
• Christine Greb, LLP
• Austin Green
• Brooke Green
• Alexis Greene, AGPCNP-BC

• Radiography Radiologic Technologist in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Radiography Radiologic Technologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; 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.