Great Lakes Diagnostic Facility LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301059644 Issued in MI

Legal business name

GREAT LAKES DIAGNOSTIC FACILITY LLC

Practice address

1525 W Caro Rd
Caro, MI 48723-9686

Phone

(989) 672-2100

Fax

(989) 672-2120

NPI assigned

Jan 9, 2015

Organization subpart

No

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

Authorized official

Name

Waqar Mian

Title

Owner

Phone

(989) 780-4415

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1420761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441843200000",
    "number": "1609265941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3061 CHRISTY WAY",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486032224",
            "telephone_number": "989-791-2455",
            "fax_number": "989-791-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 W CARO RD",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487239686",
            "telephone_number": "989-672-2100",
            "fax_number": "989-672-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES DIAGNOSTIC FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-09",
        "last_updated": "2015-09-10",
        "status": "A",
        "authorized_official_last_name": "MIAN",
        "authorized_official_first_name": "WAQAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-780-4415"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301059644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina M Gomez, RN
• Shweta Gore
• Josephine Grannell, LMSW
• Great Lake Laboratories LLC
• Great Lakes Bay Health Centers
• Christine M Greer, RN
• Robert Grenn, MD
• Trevor A. Grice, PHD
• Kathy Ann Gwizdala, LMSW
• Nancy Lynn Hacker, LBSW

• Internal Medicine Physician in Caro, MI
• Providers in Caro, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; 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.