Great Lakes Pediatric Cardiology, PLLC

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

Legal business name

GREAT LAKES PEDIATRIC CARDIOLOGY, PLLC

Practice address

43200 Dequindre Rd Ste 105
Sterling Heights, MI 48314-1707

Phone

(248) 780-9490

Fax

(248) 282-0851

NPI assigned

Nov 27, 2023

Organization subpart

No

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

Authorized official

Name

Ismael Gonzalez Rangel, MDNPI 1023244126

Title

Pediatric Cardiologist

Phone

(361) 228-5103

Specialties & licenses 1

Addresses

Other names 1

• Great Lakes Pediatric Cardiology Doing business as

Tax ID family

Great Lakes Pediatric Cardiology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Great Lakes Pediatric Cardiology PLLC

  • Pediatric Cardiology Physician
  • Sterling Heights, MI
  • NPI 1972293967
  NPD tax ID

Practitioners 1

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

• Ismael Enrique Gonzalez Rangel, MD

  • Pediatric Cardiology Physician
  • Sterling Heights, MI
  • NPI 1023244126
  NPD Authorized official

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

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1295500825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43200 DEQUINDRE RD STE 105",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141707",
            "telephone_number": "248-780-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43200 DEQUINDRE RD STE 105",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141707",
            "telephone_number": "248-780-9490",
            "fax_number": "248-282-0851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PEDIATRIC CARDIOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-27",
        "last_updated": "2023-11-27",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ RANGEL",
        "authorized_official_first_name": "ISMAEL",
        "authorized_official_title_or_position": "PEDIATRIC CARDIOLOGIST",
        "authorized_official_telephone_number": "361-228-5103",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Pediatric Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Great Homecare, Inc
• Great Lakes Carewell LLC
• Great Lakes Chiropractic, P.C.
• Great Lakes Orthopedic Physical Therapy, Inc.
• Great Lakes Pediatric Cardiology PLLC
• Great Lakes Sleep Medicine Institute PLC
• Great Reliable Services LLC
• Great Steps Clinic PC
• Greatlakes Chiropractic
• Astarta Green

• Pediatric Cardiology Physician in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Pediatric Cardiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.