Great Lakes Physicians of Southfield,PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

GREAT LAKES PHYSICIANS OF SOUTHFIELD,PLLC

Practice address

23999 Northwestern Hwy
Suite 110
Southfield, MI 48075-2578

Phone

(248) 223-1500

Fax

(248) 223-9600

NPI assigned

Jun 13, 2007

Organization subpart

No

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

Authorized official

Name

Paul M Petre, MD

Title

Owner

Phone

(248) 223-1500

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243555200000",
    "number": "1295939296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23999 NORTHWESTERN HWY",
            "address_2": "SUITE 110",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752578",
            "telephone_number": "248-223-1500",
            "fax_number": "248-223-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23999 NORTHWESTERN HWY",
            "address_2": "SUITE 110",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752578",
            "telephone_number": "248-223-1500",
            "fax_number": "248-223-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICIANS OF SOUTHFIELD,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2009-05-29",
        "status": "A",
        "authorized_official_last_name": "PETRE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-223-1500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2009; 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.