Healthcare Provider Details

I. General information

NPI: 1922494269
Provider Name (Legal Business Name): GREAT LAKES PHYSICIAN RESOURCES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COLUMBUS AVE
BAY CITY MI
48708-6831
US

IV. Provider business mailing address

1900 COLUMBUS AVE
BAY CITY MI
48708-6831
US

V. Phone/Fax

Practice location:
  • Phone: 989-894-3000
  • Fax:
Mailing address:
  • Phone: 412-418-6077
  • Fax: 770-237-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN READ
Title or Position: OWNER
Credential: MD
Phone: 412-418-6077