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General NPI Number Information
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NPI Number | 1831695543
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Entity Type | Organization
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Legal Business Name | GREAT LAKES RESEARCH GROUP, INC.
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 200 S WENONA ST STE 170
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City | BAY CITY
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State | MI
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Zip | 48706-8831
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Country | US
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Telephone | 989-895-9100
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Fax | 989-895-9200
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Provider Business Mailing Address
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Address Line | 200 S WENONA ST STE 170
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City | BAY CITY
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State | MI
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Zip | 48706-8831
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Country | US
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Telephone | 989-895-9100
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Fax | 989-895-9200
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Authorized Official
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Title or Position | SITE DIRECTOR
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Name | MRS. TERRI L VITTITOW
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Credential |
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Telephone | 989-895-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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License Number State |
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