NPIMap

Organization Active NPI

Great Lakes Cardiothoracic & Vascular Surgery PLLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Petoskey, MI
National Provider Identifier
1346283116
Registry record updated Oct 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
GREAT LAKES CARDIOTHORACIC & VASCULAR SURGERY PLLC
Practice address
2390 Mitchell Park Dr
Suite B
Petoskey, MI 49770-8965
Phone
(231) 487-9090
Fax
(231) 487-9191
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2009

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

Authorized official

Name
Dr. Brad E. Vazales, M.D.NPI 1366495285
Title
President
Phone
(231) 487-9090

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

2390 Mitchell Park Dr
Suite B
Petoskey, MI 49770-8965

Mailing address

2390 Mitchell Park Dr
Suite B
Petoskey, MI 49770-8965
Phone (231) 487-9090

Other identifiers 1

IdentifierTypeStateIssuer
780001998OtherMIRR MEDICARE

National Provider Directory

National Provider Directory

Locations

2390 Mitchell Park Dr
Ste B
Petoskey, MI 49770
Phone (231) 487-4650

560 W Mitchell St
Ste 510
Petoskey, MI 49770
Phone (231) 487-6700

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255996800000",
    "number": "1346283116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2390 MITCHELL PARK DR",
            "address_2": "SUITE B",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708965",
            "telephone_number": "231-487-9090",
            "fax_number": "231-487-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2390 MITCHELL PARK DR",
            "address_2": "SUITE B",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708965",
            "telephone_number": "231-487-9090",
            "fax_number": "231-487-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES CARDIOTHORACIC & VASCULAR SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2009-10-20",
        "status": "A",
        "authorized_official_last_name": "VAZALES",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-487-9090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "780001998",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

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