Great Lake Laboratories LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GREAT LAKE LABORATORIES LLC

Practice address

1525 W Caro Rd
Caro, MI 48723-9686

Phone

(989) 670-6000

NPI assigned

Sep 27, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Waqar Mian

Title

Medical Director

Phone

(989) 780-4415

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Naveed Mahfooz, MD

  • Internal Medicine Physician
  • Caro, MI
  • NPI 1780639450
  NPD (past)

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

{
    "created_epoch": "1411776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420156800000",
    "number": "1477956068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 513",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487230513",
            "telephone_number": "989-670-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 W CARO RD",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487239686",
            "telephone_number": "989-670-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKE LABORATORIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-27",
        "last_updated": "2015-01-02",
        "status": "A",
        "authorized_official_last_name": "MIAN",
        "authorized_official_first_name": "WAQAR",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "989-780-4415",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Lynn Gillis, LMSW, CADC-M
• Karley Autumn Glashauser, PT, DPT, CBIS
• Tina M Gomez, RN
• Shweta Gore
• Josephine Grannell, LMSW
• Great Lakes Bay Health Centers
• Great Lakes Diagnostic Facility LLC
• Christine M Greer, RN
• Robert Grenn, MD
• Trevor A. Grice, PHD

• Clinical Medical Laboratory in Caro, MI
• Providers in Caro, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2015; 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.