Great Lakes Medical LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GREAT LAKES MEDICAL LLC

Practice address

8153 S 27TH St
Franklin, WI 53132-7012

Phone

(773) 885-7696

Fax

(773) 409-5710

NPI assigned

May 15, 2009

Organization subpart

Yes

Parent organization

GREAT LAKES FOOT & ANKLE CENTERS OF GREATER MILWAUKEE LLCAs reported in NPPES

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

Authorized official

Name

Dr. John L Bostanche, DPM

Title

Director

Phone

(262) 657-3668

Specialties & licenses 1

Addresses

Part of

Great Lakes Foot Ankle Cen

Locations

Practitioners 1

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

• Robert D Matteucci, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Franklin, WI
  • NPI 1164426763
  NPD (past)

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

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300147200000",
    "number": "1497980759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT 7917",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "60122",
            "telephone_number": "773-885-7696",
            "fax_number": "773-409-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8153 S 27TH ST",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "531327012",
            "telephone_number": "773-885-7696",
            "fax_number": "773-409-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES MEDICAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT LAKES FOOT & ANKLE CENTERS OF GREATER MILWAUKEE LLC",
        "enumeration_date": "2009-05-15",
        "last_updated": "2011-03-15",
        "status": "A",
        "authorized_official_last_name": "BOSTANCHE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "262-657-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adriana Gonzalez
• Donna J Grabski, APNP
• Timothy J Grass, D.O.
• Great Lakes Anesthesia and Pain Specialists SC
• Great Lakes Foot & Ankle of Greater Milwaukee
• Great Lakes Pain Specialists, LLC
• Jennifer Theresa Grimm, RPH
• Michelle L Gruenewald, R.N.
• Rita Ann Grulkowski, RN
• Gsdavis Opco-1, LLC

• Ambulatory Surgical Clinic/Center in Franklin, WI
• Providers in Franklin, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; 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.