Great Lakes Physicians PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GREAT LAKES PHYSICIANS PC

Practice address

36180 Five Mile Road
Livonia, MI 48154

Phone

(734) 591-7666

Fax

(734) 591-2426

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Jayshree Desai, MDNPI 1396752283

Title

Owner

Phone

(734) 591-7666

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jayshree M Desai, MD

  • Internal Medicine Physician
  • Livonia, MI
  • NPI 1396752283
  Medicare reassignment Care Compare group NPD Authorized official
• Surendra Kelwala, MD

  • Psychiatry Physician
  • Livonia, MI
  • NPI 1558475517
  Medicare reassignment Care Compare group NPD
• Anil K Jain, M.D.

  • Psychiatry Physician
  • West Bloomfield, MI
  • NPI 1013027309
  NPD (past)

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1164591053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36180 FIVE MILE ROAD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "48154",
            "telephone_number": "734-591-7666",
            "fax_number": "734-591-2426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36180 FIVE MILE ROAD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "48154",
            "telephone_number": "734-591-7666",
            "fax_number": "734-591-2426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICIANS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "DESAI",
        "authorized_official_first_name": "JAYSHREE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-591-7666",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3323140",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gray Fox Counseling, PLLC
• Logan Gray, MSW, LLMSW
• Great Lakes Adult Day Services, LLC
• Great Lakes Family Dental Group-Livonia, P.C.
• Great Lakes Foot & Ankle Institute PLLC
• Great Lakes Smiles
• Great-Lakes Restorative Counseling LLC
• Greater Michigan Chiropractic, PC
• Kristen Grebene
• Ashley Green

• Internal Medicine Physician in Livonia, MI
• Providers in Livonia, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.