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GREAT LAKES HOME DOCTORS PC NPI 1679705354


NPI Information

NPI: 1679705354
Provider Name: GREAT LAKES HOME DOCTORS PC

Doing Business As: PATIENT CARE CLINIC

Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
1160 VILLA CT N
WALLED LAKE, MI
ZIP 48390
Phone: (313) 978-2343
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GREAT LAKES HOME DOCTORS PC is a general practice in Walled Lake, MI. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee GREAT LAKES HOME DOCTORS PC NPI is 1679705354. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Patient Care Clinic.

The provider's business location address is:

1160 VILLA CT N
WALLED LAKE, MI
ZIP 48390-376
Phone: (313) 978-2343

The provider's authorized official is Aundrey Lutskovsky .
The authorized official title is Owner and has the following contact phone number (313) 978-2343.

The enumeration date for this NPI number is 8/14/2009 and was last updated on 4/15/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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