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General NPI Number Information
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NPI Number | 1144111840
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Entity Type | Organization
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Legal Business Name | GREAT LAKES UROGYNECOLOGY PLC
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 19249 ALLEN RD STE B
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-1189
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Country | US
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Telephone | 248-835-2797
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Fax |
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Provider Business Mailing Address
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Address Line | 19249 ALLEN RD STE B
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-1189
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Country | US
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Telephone | 734-225-6859
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. JACLYN TAYLOR BARATONO
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Credential |
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Telephone | 734-225-6859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number |
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License Number State |
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