Great Lakes Practitioners LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

4184295 Issued in OH

Legal business name

GREAT LAKES PRACTITIONERS LLC

Practice address

6681 Ridge Rd Ste 300
Parma, OH 44129-5705

Phone

(440) 842-8675

NPI assigned

Jun 4, 2018

Organization subpart

No

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

Authorized official

Name

Kourosh Saghafi, DONPI 1659358950

Title

President

Phone

(440) 842-8675

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Kourosh Saghafi

  • Geriatric Medicine (Internal Medicine) Physician
  • Parma, OH
  • NPI 1659358950
  Authorized official Same address or phone

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

{
    "created_epoch": "1528070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1689166860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6681 RIDGE RD STE 300",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441295705",
            "telephone_number": "440-842-8675",
            "fax_number": "440-842-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6681 RIDGE RD STE 300",
            "city": "PARMA",
            "state": "OH",
            "postal_code": "441295705",
            "telephone_number": "440-842-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PRACTITIONERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-04",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "SAGHAFI",
        "authorized_official_first_name": "KOUROSH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-842-8675",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "4184295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO BUSINESS LICENSE",
            "identifier": "4184295",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Romie Graham
• Camille Grant, LPN
• Tiffany N Grant, CNA
• Javonne Renee' Gray, CNM
• Great Lakes Physicians LLC
• Daniel Harold Greathouse III, M.S.
• Sara M Green, MACCC-SLP
• Leslie R Greenberg, DDS
• Anthony Warren Greene
• Sierra I Greer, LSW

• Geriatric Medicine (Internal Medicine) Physician in Parma, OH
• Providers in Parma, OH by specialty
• Geriatric Medicine (Internal Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; 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.