Green Lake Medical Supply, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

GREEN LAKE MEDICAL SUPPLY, INC

Practice address

93 Kercheval Ave
Grosse Pointe Farms, MI 48236-3600

Phone

(313) 882-3900

Fax

(313) 882-3947

NPI assigned

May 2, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Robert Lee Moorhead

Title

President

Phone

(313) 882-3900

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1740401017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18530 MACK AVE STE 411",
            "city": "GROSSE POINTE FARMS",
            "state": "MI",
            "postal_code": "482363254",
            "telephone_number": "313-882-3900",
            "fax_number": "313-882-3947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 KERCHEVAL AVE",
            "city": "GROSSE POINTE FARMS",
            "state": "MI",
            "postal_code": "482363600",
            "telephone_number": "313-882-3900",
            "fax_number": "313-882-3947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LAKE MEDICAL SUPPLY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MOORHEAD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-882-3900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3141989",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Ginnebaugh, MD
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• Susan R Grabowski, DO
• Margaret Leigh Gratson, RN
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• Peggy Ellen Greene
• Grosse Pointe Anesthesiologists, PC
• Grosse Pointe Comprehensive Care
• Grosse Pointe Family Dentistry
• Grosse Pointe Physiatry, PLLC

• Durable Medical Equipment & Medical Supplies in Grosse Pointe Farms, MI
• Providers in Grosse Pointe Farms, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.