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General NPI Number Information
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NPI Number | 1366589996
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Entity Type | Organization
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Legal Business Name | GREAT LAKES GYNECOLOGY & AESTHETICS INC, PC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 126 S 25TH ST SUITE B
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City | ESCANABA
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State | MI
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Zip | 49829-1364
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Country | US
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Telephone | 906-233-9500
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Fax | 906-233-9925
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Provider Business Mailing Address
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Address Line | 126 SOUTH 25TH STREET SUITE B
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City | ESCANABA
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State | MI
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Zip | 49829
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Country | US
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Telephone | 906-233-9500
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Fax | 906-233-9925
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Authorized Official
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Title or Position | PHYSICIAN-SURGEON
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Name | DR. DAVID LUIS HAMACHER
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Credential | MD,FACOG
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Telephone | 906-233-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 207VG0400X
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License Number State | MI
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