Great Lakes Specialists LLC

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

Legal business name

GREAT LAKES SPECIALISTS LLC

Practice address

1525 E Beltline Ave NE Ste 101
Grand Rapids, MI 49525-4598

Phone

(877) 786-2040

Fax

(302) 261-7479

NPI assigned

Jan 23, 2025

Organization subpart

No

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

Authorized official

Name

Aamir Abbas

Title

Owner of Entity

Phone

(877) 786-2040

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1737590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1720890098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 E BELTLINE AVE NE STE 101",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495254598",
            "telephone_number": "877-786-2040",
            "fax_number": "302-261-7479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E BELTLINE AVE NE STE 101",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495254598",
            "telephone_number": "877-786-2040",
            "fax_number": "302-261-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-23",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "ABBAS",
        "authorized_official_first_name": "AAMIR",
        "authorized_official_title_or_position": "OWNER OF ENTITY",
        "authorized_official_telephone_number": "877-786-2040"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Interventional Cardiology Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Interventional Cardiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; 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.