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General NPI Number Information
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NPI Number | 1023799384
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Entity Type | Organization
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Legal Business Name | GREAT LAKES DURABLE MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 12701 TELEGRAPH RD STE 205
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City | TAYLOR
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State | MI
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Zip | 48180-6851
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Country | US
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Telephone | 734-643-5028
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Fax |
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Provider Business Mailing Address
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Address Line | 9285 COUNTRY VIEW DR
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City | YPSILANTI
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State | MI
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Zip | 48197-6651
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Country | US
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Telephone | 734-489-3094
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IMAN AHMED
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Credential |
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Telephone | 678-431-9281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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