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General NPI Number Information
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NPI Number | 1275912875
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Entity Type | Organization
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Legal Business Name | GREAT LAKES BAY HEALTH CENTERS
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 15855 19 MILE RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-3504
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Country | US
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Telephone | 586-263-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 501 LAPEER AVE
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City | SAGINAW
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State | MI
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Zip | 48607-1203
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Country | US
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Telephone | 989-759-6464
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Fax | 989-399-8233
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Authorized Official
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Title or Position | INTERUM PRESIDENT
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Name | LISA GALONSKA
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Credential |
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Telephone | 989-759-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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