Great Lakes Neurology, PC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

SH067274 Issued in MI

Legal business name

GREAT LAKES NEUROLOGY, PC

Practice address

932 Spring St Ste 102
Petoskey, MI 49770-2286

Phone

(231) 487-3970

NPI assigned

Oct 25, 2006

Last updated

Feb 21, 2012By 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

Dr. Steven Huder

Title

President

Phone

(231) 487-3970

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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.

• Christine Aileen Kidder, D.O

  • Neurology Physician
  • Farmington Hills, MI
  • NPI 1689888208
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329782400000",
    "number": "1811071798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "932 SPRING ST STE 102",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "932 SPRING ST STE 102",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702286",
            "telephone_number": "231-487-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES NEUROLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2012-02-21",
        "status": "A",
        "authorized_official_last_name": "HUDER",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-487-3970",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "SH067274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3514160",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rodney J Grambeau Jr., DDS
• Brenden Charles Grangood, DPT
• Great Lakes Cardiothoracic & Vascular Surgery PLLC
• Great Lakes Digestive Health Assc PC
• Great Lakes Ear Nose & Throat Specialists PC
• Great Lakes Oral and Maxillofacial Surgery P.C.
• Great Lakes TTC,LLC
• John K. Grebe, PSY.D.
• Charles R Green, PA-C
• Aaron Charles Greene, P.A.

• Neurology Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Neurology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; 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.