Healthcare Provider Details

I. General information

NPI: 1508819475
Provider Name (Legal Business Name): GREAT LAKES SENIORS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27500 HOOVER RD
WARREN MI
48093-4586
US

IV. Provider business mailing address

33006 7 MILE RD # 176
LIVONIA MI
48152-1358
US

V. Phone/Fax

Practice location:
  • Phone: 800-836-2904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ORIN HALL
Title or Position: PRESIDENT
Credential:
Phone: 586-427-4453