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NPI Code Detail

MEDICARE: GREAT LAKES AMBULATORY SURGERY CENTER

MEDICARE: GREAT LAKES AMBULATORY SURGERY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center35-075570OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023498219
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT LAKES AMBULATORY SURGERY CENTER
Provider Business Mailing Address
First Line : 9002 MENTOR AVE
Second Line :
City : MENTOR
State : OH
Zip : 44060-6302
Country : US
Telephone Number : 440-306-2358
Fax Number : 440-306-2359
Provider Business Practice Location Address
First Line : 9002 MENTOR AVE STE B
Second Line :
City : MENTOR
State : OH
Zip : 44060-6302
Country : US
Telephone Number : 440-283-0244
Fax Number : 440-283-0247
Authorized Official
Title or Position : OWNER
Name : DR. EMAD AZMY MIKHAIL
Credential : M.D.
Telephone Number : 440-306-2358
Provider Enumeration Date : 06/03/2015
Last Update Date : 01/13/2026

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Directions to “GREAT LAKES AMBULATORY SURGERY CENTER ” Practice Location

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