Great Lakes Pediatric Neurology

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

GREAT LAKES PEDIATRIC NEUROLOGY

Practice address

1331 Monroe St
Dearborn, MI 48124-2888

Phone

(248) 851-1700

Fax

(248) 851-3830

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Yasser Awaad, MD

Title

President

Phone

(248) 851-1700

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417017476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 MONROE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242888",
            "telephone_number": "248-851-1700",
            "fax_number": "248-851-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 MONROE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242888",
            "telephone_number": "248-851-1700",
            "fax_number": "248-851-3830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PEDIATRIC NEUROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AWAAD",
        "authorized_official_first_name": "YASSER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-851-1700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffery Allen Grayson
• Great Lakes Cardiovascular & Thoracic Surgeons
• Great Lakes Med Solutions LLC
• Great Lakes Medical Laboratories, Inc.
• Great Lakes Musculoskeletal Ultrasound Inc.
• Great Lakes Porter SVC
• Great Lakes Reading, PLLC
• Greater Detroit Community Care
• Greater Michigan Cardiovascular Surgeons PLC
• Kristie K Greear, PA-C

• Medical Specialty Clinic/Center in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Medical Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.