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General NPI Number Information
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NPI Number | 1841323755
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Entity Type | Organization
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Legal Business Name | GREAT LAKES SUGICAL PARTNERS, LTD.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 1050 ISAAC STREETS DR SUITE 131
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City | OREGON
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State | OH
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Zip | 43616-3291
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Country | US
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Telephone | 419-690-0888
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Fax | 419-690-8228
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Provider Business Mailing Address
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Address Line | 1050 ISAAC STREETS DR SUITE 131
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City | OREGON
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State | OH
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Zip | 43616-3291
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Country | US
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Telephone | 419-690-0888
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Fax | 419-690-8228
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LISA M. BRAUN
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Credential |
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Telephone | 419-690-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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