Great Lakes Medical Devices

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

GREAT LAKES MEDICAL DEVICES

Practice address

105 E 2ND St Unit H
Davison, MI 48423-1467

Phone

(810) 447-0135

NPI assigned

Jan 19, 2024

Last updated

Aug 27, 2025By 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

Derek Humphrey

Title

Owner

Phone

(810) 701-6418

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756252800000",
    "number": "1184485963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3196 S IRISH RD",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484232434",
            "telephone_number": "810-701-6418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E 2ND ST UNIT H",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484231467",
            "telephone_number": "810-447-0135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES MEDICAL DEVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-19",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-701-6418"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hollie Gohr, RN, FNP
• Maria E Goleba, MD
• Laura Lisa Gonzalez, M.A
• Michelle Lee Gonzalez, LMFT
• Great Lakes in-Home Clinician Services Inc (Elite Medical Services, Inc.)
• Ryan Grossman
• Willie Grover
• Ann Guidry
• Laith F. Gulli, M.D.,M.SC.,MSA,M.SC.
• Suresh C Gupta, MD

• Durable Medical Equipment & Medical Supplies in Davison, MI
• Providers in Davison, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.