Great Lakes Spine Sports & Pain, PLLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

GREAT LAKES SPINE SPORTS & PAIN, PLLC

Practice address

4676 E Broomfield Rd Ste a
Mt Pleasant, MI 48858-9192

Phone

(989) 772-3800

Fax

(840) 626-4066

NPI assigned

Aug 2, 2006

Organization subpart

No

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

Authorized official

Name

Bachu Abraham, M.D.NPI 1225045024

Title

President

Phone

(989) 772-3800

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bachu Abraham, M.D.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Mt Pleasant, MI
  • NPI 1225045024
  NPD (past) Authorized official
• Piyush Parshottambhai Patel, RPT

  • Physical Therapist
  • Lake City, MI
  • NPI 1144510090
  NPD (past)
• Vivek Thakore, BS MS RPT

  • Physical Therapy Clinic/Center
  • Ludington, MI
  • NPI 1609986405
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1780691808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 87",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496010087",
            "telephone_number": "231-775-6076",
            "fax_number": "231-775-0027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4676 E BROOMFIELD RD STE A",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488589192",
            "telephone_number": "989-772-3800",
            "fax_number": "840-626-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES SPINE SPORTS & PAIN, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "ABRAHAM",
        "authorized_official_first_name": "BACHU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "989-772-3800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Christine Gourlay, M.A.
• Jeffery Ryan Govitz
• Christine L Gransden, NP
• Great Lakes Medical PC
• Great Lakes Psychological Associates PLLC
• Greater Michigan Spine & Neurologic Institute, PC
• Allison Green
• Katelyn Rae Green
• Holli Greenacre, MS
• Sue Greenwood, RN

• Physical Medicine & Rehabilitation Physician in Mt Pleasant, MI
• Providers in Mt Pleasant, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; 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.