Great Lakes Orthotics & Medical Supply, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.

Practice address

1670 Miller Park Way
West Milwaukee, WI 53214-3604

Phone

(414) 897-8380

Fax

(262) 436-1711

NPI assigned

Apr 6, 2016

Last updated

Aug 9, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Seamus Buggy

Title

President

Phone

(414) 828-9256

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Great Lakes Orthotics and Medical Supply Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Great Lakes Orthotics & Medical Supply, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Brown Deer, WI
  • NPI 1891373593
  NPD tax ID
• Great Lakes Orthotics and Medical Supply, Inc

  • Durable Medical Equipment & Medical Supplies
  • West Allis, WI
  • NPI 1710308200
  NPD tax ID

Locations

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

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786233600000",
    "number": "1770947897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 MILLER PARK WAY",
            "city": "WEST MILWAUKEE",
            "state": "WI",
            "postal_code": "532143604",
            "telephone_number": "414-897-8380",
            "fax_number": "262-436-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 MILLER PARK WAY",
            "city": "WEST MILWAUKEE",
            "state": "WI",
            "postal_code": "532143604",
            "telephone_number": "414-897-8380",
            "fax_number": "262-436-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-06",
        "last_updated": "2026-08-09",
        "certification_date": "2026-08-09",
        "status": "A",
        "authorized_official_last_name": "BUGGY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SEAMUS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-828-9256",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100063060",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Ann Gentile, DDS
• Aleksandr Gershteyn, PHARM.D.
• Epiphany A Gold, LPN
• Laura Elizabeth Goodell, D.M.D.
• Sandra Graham
• Michael Gremban
• Trista M Grudzinski, LPN
• Audra L Hale, APNP
• Kourtney K Haller, RN
• Hanger Prosthetics & Orthotics East Inc (Hanger Clinic)

• Durable Medical Equipment & Medical Supplies in West Milwaukee, WI
• Providers in West Milwaukee, WI by specialty
• Durable Medical Equipment & Medical Supplies in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.