Greater Lakes Anesthesia, PLLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

GREATER LAKES ANESTHESIA, PLLC

Practice address

16100 19 Mile Rd
Clinton Township, MI 48038-1148

Phone

(586) 286-0000

Fax

(586) 286-0005

NPI assigned

Oct 12, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Patricia Clark

Title

Office Manager

Phone

(973) 777-7879

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1255305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255305600000",
    "number": "1558696351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 CLIFTON AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070132711",
            "telephone_number": "973-777-7879",
            "fax_number": "973-777-6738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16100 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381148",
            "telephone_number": "586-286-0000",
            "fax_number": "586-286-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER LAKES ANESTHESIA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-12",
        "last_updated": "2009-10-12",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "973-777-7879",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Provider Network, LLC
• Great Lakes Shuttle Company, LLC
• Great Lakes Sleep Center LLC
• Great Start Mihp LLC
• Greater Lakes Ambulatory Surgical Center, LLC (Greater Lakes Ambulatory Surgery Center)
• Greater Michigan Gastroenterology PC
• Greatlakes Homecare Center LLC
• Daniel James Green, RN
• Debora Green, LPC
• Eboni Green

• Anesthesiology Physician in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Anesthesiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2009; 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.