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General NPI Number Information
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NPI Number | 1316245343
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Entity Type | Organization
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Legal Business Name | GREAT LAKES PROSTHETICS AND BUSCH DANIEL J MEMBER
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 5315 ELLIOTT DR SUITE 104
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City | YPSILANTI
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State | MI
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Zip | 48197-8634
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Country | US
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Telephone | 734-528-5200
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Fax | 734-528-5260
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Provider Business Mailing Address
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Address Line | 5315 ELLIOTT DR SUITE 104
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City | YPSILANTI
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State | MI
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Zip | 48197-8634
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Country | US
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Telephone | 734-528-5200
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Fax | 734-528-5260
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. CHRISTOPHER JAMES FAIRMAN
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Credential | CPO
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Telephone | 734-528-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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