Great Lakes Digestive Health Assc PC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

4301091670 Issued in MI

Legal business name

GREAT LAKES DIGESTIVE HEALTH ASSC PC

Practice address

560 W Mitchell St
Ste M40
Petoskey, MI 49770-2278

Phone

(231) 487-2391

Fax

(231) 487-6513

NPI assigned

Oct 15, 2007

Organization subpart

No

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

Authorized official

Name

Pamela Stoner

Title

Administrator

Phone

(231) 487-2391

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1285822387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST",
            "address_2": "STE M40",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702278",
            "telephone_number": "231-487-2391",
            "fax_number": "231-487-6513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST",
            "address_2": "STE M40",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702278",
            "telephone_number": "231-487-2391",
            "fax_number": "231-487-6513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES DIGESTIVE HEALTH ASSC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "STONER",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "231-487-2391"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301091670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285822387",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandria Karolina Graham
• Christopher Graham, LPC
• Rodney J Grambeau Jr., DDS
• Brenden Charles Grangood, DPT
• Great Lakes Cardiothoracic & Vascular Surgery PLLC
• Great Lakes Ear Nose & Throat Specialists PC
• Great Lakes Neurology, PC
• Great Lakes Oral and Maxillofacial Surgery P.C.
• Great Lakes TTC,LLC
• John K. Grebe, PSY.D.

• Gastroenterology Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Gastroenterology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.