Great Lakes Cardiovascular Thoracic Surgery, PLC

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

5101009076 Issued in MI

Legal business name

GREAT LAKES CARDIOVASCULAR THORACIC SURGERY, PLC

Doing business as

great lakes vein center

Practice address

7901 S 12TH St
Suite 201
Portage, MI 49024-3831

Phone

(269) 372-8687

NPI assigned

Aug 22, 2006

Organization subpart

No

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

Authorized official

Name

Dr. George Joseph Mack, D.O.

Title

President

Phone

(269) 372-8687

Specialties & licenses 1

Addresses

Other names 1

• great lakes vein center Doing business as

Locations

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1487760427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7901 S 12TH ST",
            "address_2": "SUITE 201",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490243831",
            "telephone_number": "269-372-8687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 S 12TH ST",
            "address_2": "SUITE 201",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490243831",
            "telephone_number": "269-372-8687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES CARDIOVASCULAR THORACIC SURGERY, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-372-8687",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MI",
            "license": "5101009076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "great lakes vein center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michele Grantham
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• Luigi Greco, O.D.

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Portage, MI
• Providers in Portage, MI by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.