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General NPI Number Information
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NPI Number | 1811071798
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Entity Type | Organization
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Legal Business Name | GREAT LAKES NEUROLOGY, PC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 932 SPRING ST STE 102
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City | PETOSKEY
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State | MI
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Zip | 49770-2286
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Country | US
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Telephone | 231-487-3970
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Fax |
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Provider Business Mailing Address
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Address Line | 932 SPRING ST STE 102
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City | PETOSKEY
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State | MI
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Zip | 49770-2855
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN HUDER
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Credential |
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Telephone | 231-487-3970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | SH067274
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License Number State | MI
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