Great Lakes Internal Medicine, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GREAT LAKES INTERNAL MEDICINE, PC

Practice address

427 Seminole Rd
Suite 100
Muskegon, MI 49444-3747

Phone

(231) 739-6000

Fax

(231) 739-6004

NPI assigned

Nov 30, 2007

Last updated

Nov 30, 2007By 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. Herbert F Miller, M.D.

Title

President

Phone

(231) 739-6000

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.

• Tabetha Emily Bergeron, PA-C

  • Physician Assistant
  • Grand Rapids, MI
  • NPI 1003228925
  NPD (past)

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1235311382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 SEMINOLE RD",
            "address_2": "SUITE 100",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494443747",
            "telephone_number": "231-739-6000",
            "fax_number": "231-739-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 SEMINOLE RD",
            "address_2": "SUITE 100",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494443747",
            "telephone_number": "231-739-6000",
            "fax_number": "231-739-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES INTERNAL MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-739-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Lynne Gravlin, OTR
• Carrie J Gray, LMSW
• Kathleen Marie Gray, PA
• Shakia Gray
• Great Lakes Hope LLC
• Great Lakes OBGYN Specialist
• Great Lakes Obstetric Gynecological Specialists PLC
• Great Lakes Specialty Hosptial - Hackley LLC (Select Specialty Hospital - Muskegon)
• Greater Grace Assemblies and Networks (Open Gates of Grace)
• Angela Kay Green, PHARM.D.

• Internal Medicine Physician in Muskegon, MI
• Providers in Muskegon, 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 Nov 30, 2007; 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.