Great Lakes Gastroenterology Consultants, LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

GREAT LAKES GASTROENTEROLOGY CONSULTANTS, LLC

Practice address

2702 Navarre Ave
Suite 106
Oregon, OH 43616-3223

Phone

(419) 696-5555

Fax

(419) 696-8499

NPI assigned

Jan 3, 2007

Organization subpart

No

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

Authorized official

Name

Sudhakar N. Pangulur, M.D.

Title

President

Phone

(419) 696-5555

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1821155177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 NAVARRE AVE",
            "address_2": "SUITE 106",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163223",
            "telephone_number": "419-696-5555",
            "fax_number": "419-696-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2702 NAVARRE AVE",
            "address_2": "SUITE 106",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163223",
            "telephone_number": "419-696-5555",
            "fax_number": "419-696-8499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES GASTROENTEROLOGY CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "PANGULUR",
        "authorized_official_first_name": "SUDHAKAR",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-696-5555",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2286262",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claire Marie Golovoy, PHARMD, RPH
• Charity Gottfried, PHARMD
• Ethan Richard Goulet
• Tambria Graham
• Elizabeth Kidder Grames, APRN
• Great Lakes Sugical Partners, LTD.
• Sierra N Green, LPN
• Marie Morelli Greenbaum, D.O.
• Mitchell Gordon Greenbaum, D.O.
• Prabhsharn Singh Grewal, MD

• Gastroenterology Physician in Oregon, OH
• Providers in Oregon, OH by specialty
• Gastroenterology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; 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.