Healthcare Provider Details

I. General information

NPI: 1881305712
Provider Name (Legal Business Name): GREAT LAKES HEALTH FOUNDATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4046 HESS AVE
SAGINAW MI
48601-4261
US

IV. Provider business mailing address

3061 CHRISTY WAY STE A
SAGINAW MI
48603-2224
US

V. Phone/Fax

Practice location:
  • Phone: 989-245-6633
  • Fax: 989-355-0735
Mailing address:
  • Phone: 989-860-0088
  • Fax: 989-355-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. NAVEED MAHFOOZ
Title or Position: OWNER
Credential: MD
Phone: 989-245-6633