Great Lakes Neuromonitoring, PLLC

Primary specialty

Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X

Legal business name

GREAT LAKES NEUROMONITORING, PLLC

Practice address

5119 Highland Rd
(M-59) #389
Waterford, MI 48327-1915

Phone

(248) 309-6631

NPI assigned

Dec 7, 2017

Organization subpart

No

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

Authorized official

Name

Lizette Morin

Title

MDMS Npi Compliance Officer

Phone

(210) 598-2801

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512604800000",
    "number": "1457866873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5119 HIGHLAND RD",
            "address_2": "(M-59) #389",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271915",
            "telephone_number": "248-309-6631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5119 HIGHLAND RD",
            "address_2": "(M-59) #389",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271915",
            "telephone_number": "248-309-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES NEUROMONITORING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-07",
        "last_updated": "2017-12-07",
        "status": "A",
        "authorized_official_last_name": "MORIN",
        "authorized_official_first_name": "LIZETTE",
        "authorized_official_title_or_position": "MDMS NPI COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "210-598-2801"
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246ZE0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelbi Grant, CPT
• David Lashawn Graves
• Kateri Gray, LLMSW
• Samuel Adam Gray, DC
• Great Lakes Clinical Group, P.C
• Great Lakes Podiatry Associates PLLC
• Greater Oakland Visiting Nurse Association, Inc.
• Susan Marie Grech, RN
• Briana Greenlee, RDN
• Greentechconcept

• Clinical Neurophysiology Physician in Waterford, MI
• Providers in Waterford, MI by specialty
• Clinical Neurophysiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; 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.