NPIMap

Organization Active NPI

Great Lakes Gynecology & Aesthetics Inc, PC

  • Gynecology Physician
  • Escanaba, MI
National Provider Identifier
1366589996
Registry record updated Sep 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
207VG0400X Issued in MI
Legal business name
GREAT LAKES GYNECOLOGY & AESTHETICS INC, PC
Practice address
126 S 25TH St
Suite B
Escanaba, MI 49829-1364
Phone
(906) 233-9500
Fax
(906) 233-9925
NPI assigned
Jan 31, 2007
Last updated
Sep 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2009

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

Authorized official

Name
Dr. David Luis Hamacher, MD,FACOGNPI 1851307961
Title
Physician-Surgeon
Phone
(906) 233-9500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 207VG0400X MI Primary

Addresses

Primary practice location

126 S 25TH St
Suite B
Escanaba, MI 49829-1364

Mailing address

126 South 25TH Street
Suite B
Escanaba, MI 49829
Phone (906) 233-9500

Other identifiers 1

IdentifierTypeStateIssuer
4662541MedicaidMI

National Provider Directory

National Provider Directory

Locations

126 S 25th St
Escanaba, MI 49829
Phone (906) 233-9500

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": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254096000000",
    "number": "1366589996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 SOUTH 25TH STREET",
            "address_2": "SUITE B",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "49829",
            "telephone_number": "906-233-9500",
            "fax_number": "906-233-9925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 S 25TH ST",
            "address_2": "SUITE B",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291364",
            "telephone_number": "906-233-9500",
            "fax_number": "906-233-9925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES GYNECOLOGY & AESTHETICS INC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2009-09-28",
        "status": "A",
        "authorized_official_last_name": "HAMACHER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "PHYSICIAN-SURGEON",
        "authorized_official_telephone_number": "906-233-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD,FACOG"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "MI",
            "license": "207VG0400X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4662541",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Escanaba, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.