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General NPI Number Information
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NPI Number | 1023498219
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Entity Type | Organization
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Legal Business Name | GREAT LAKES AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 9002 MENTOR AVE STE B
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City | MENTOR
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State | OH
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Zip | 44060-6302
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Country | US
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Telephone | 440-283-0244
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Fax | 440-283-0247
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Provider Business Mailing Address
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Address Line | 9002 MENTOR AVE
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City | MENTOR
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State | OH
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Zip | 44060-6302
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Country | US
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Telephone | 440-306-2358
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Fax | 440-306-2359
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Authorized Official
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Title or Position | OWNER
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Name | DR. EMAD AZMY MIKHAIL
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Credential | M.D.
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Telephone | 440-306-2358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 35-075570
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License Number State | OH
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