MEDICARE: GREAT LAKES ORTHOPAEDICS

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	540H227020	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1063559391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES ORTHOPAEDICS

Provider Business Mailing Address
First Line	:	6255 INKSTER RD STE 103
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2538
Country	:	US
Telephone Number	:	734-422-8400
Fax Number	:	734-422-8563

Provider Business Practice Location Address
First Line	:	6255 INKSTER RD STE 103
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2538
Country	:	US
Telephone Number	:	734-422-8400
Fax Number	:	734-422-8563

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFERY E LAWLEY
Credential	:	D.O.
Telephone Number	:	734-422-8400

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	03/20/2013

Similar Medicare Providers

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Practice Location Address:

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1932143013 — DR. WILLIAM DAVIDSON D.O.
Practice Location Address:

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1144355934 — AMAL MOUSTAFA OMRAN MD
Practice Location Address:

6255 INKSTER RD STE 204
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Practice Fax:

1023229036 — DR. SRUTHI KONDUR MD
Practice Location Address:

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1285837591 — MRS. SUSAN GITTERMAN M.A.,CCC-A
Practice Location Address:

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Directions to “GREAT LAKES ORTHOPAEDICS ” Practice Location

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