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

Last updated

May 19, 2010By the provider in NPPES

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, MDNPI 1649236829

Title

President

Phone

(715) 735-8067

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, and the practitioner matching its NPPES authorized official.

• Edgar J Massabni, MD

  • Interventional Cardiology Physician
  • Marinette, WI
  • NPI 1649236829
  Authorized official Same address or phone

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.