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General NPI Number Information
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NPI Number | 1811096548
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Entity Type | Organization
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Legal Business Name | GREAT LAKES PHYSIATRISTS PC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 25311 LITTLE MACK AVE SUITE B
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City | ST CLAIR SHORES
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State | MI
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Zip | 48081
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Country | US
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Telephone | 586-498-2400
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Fax | 586-498-2800
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Provider Business Mailing Address
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Address Line | 8301 RELIABLE PKWY
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City | CHICAGO
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State | IL
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Zip | 60686-0083
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Country | US
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Telephone | 586-498-2400
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Fax | 586-498-2800
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK S POLLINA
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Credential | MD
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Telephone | 586-498-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301045967
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License Number State | MI
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