Great Lakes Prosthetics & Orthotics, Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

GREAT LAKES PROSTHETICS & ORTHOTICS, INC

Practice address

5315 Elliott Dr
Suite 104
Ypsilanti, MI 48197-8634

Phone

(734) 528-5200

Fax

(734) 528-5260

NPI assigned

Aug 24, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Daniel J Busch, CO

Title

Orthotist/Owner

Phone

(734) 528-5200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287964800000",
    "number": "1407963325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5315 ELLIOTT DR",
            "address_2": "SUITE 104",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978634",
            "telephone_number": "734-528-5200",
            "fax_number": "734-528-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5315 ELLIOTT DR",
            "address_2": "SUITE 104",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978634",
            "telephone_number": "734-528-5200",
            "fax_number": "734-528-5260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PROSTHETICS & ORTHOTICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2010-10-25",
        "status": "A",
        "authorized_official_last_name": "BUSCH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ORTHOTIST/OWNER",
        "authorized_official_telephone_number": "734-528-5200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas R Gravelyn, M.D.
• Colleen Graves, PA
• Ciara Gravlin
• Brooklyn Gray
• Lakeya Gray
• Great Lakes Prosthetics and Busch Daniel J Member
• Great Lakes Visiting Physicians PC
• Anthony S. Grech, M.D.
• Green Kleen LLC
• Chace Green

• Prosthetic/Orthotic Supplier in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Prosthetic/Orthotic Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.