Great Lakes Heart and Vascular, LLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

GREAT LAKES HEART AND VASCULAR, LLC

Practice address

3100 Shore Dr
Marinette, WI 54143-4242

Phone

(715) 735-8067

NPI assigned

May 19, 2010

Organization subpart

No

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

Authorized official

Name

Edgar J Massabni, MD

Title

President

Phone

(715) 735-8067

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274227200000",
    "number": "1487973269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 LIBERTY BELL RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543136992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SHORE DR",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541434242",
            "telephone_number": "715-735-8067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES HEART AND VASCULAR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-19",
        "last_updated": "2010-05-19",
        "status": "A",
        "authorized_official_last_name": "MASSABNI",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-735-8067",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Garrett Gossman, M.D.
• Jacqueline A Gouge, APNP
• Erik K Graglia, OCCUPATIONAL THERAPI
• Alison Granquist, LCSW
• Great Blue Dental, LLC
• Nicholas Patrick Grimm, PA-C
• Brianna Grosso
• Terri Lynn Grun, LPN
• Melissa Guay, BSN, RN
• Adam Mehmet Gulhan, MD

• Cardiovascular Disease Physician in Marinette, WI
• Providers in Marinette, WI by specialty
• Cardiovascular Disease Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2010; 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.