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General NPI Number Information
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NPI Number | 1366478026
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Entity Type | Organization
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Legal Business Name | GREAT LAKES OBSTETRIC GYNECOLOGICAL SPECIALISTS PLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 1775 WELLS AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-2459
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Country | US
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Telephone | 231-773-9048
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Fax | 231-777-1218
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Provider Business Mailing Address
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Address Line | 1775 WELLS AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-2459
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Country | US
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Telephone | 231-773-9048
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Fax | 231-777-1218
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MARK T KARNES
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Credential | DO
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Telephone | 231-773-9048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MK008760
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License Number State | MI
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