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NPI Code Detail

MEDICARE: GREAT LAKES FAMILY MEDICAL CENTER PLLC

MEDICARE: GREAT LAKES FAMILY MEDICAL CENTER PLLC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1598737769
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT LAKES FAMILY MEDICAL CENTER PLLC
Provider Business Mailing Address
First Line : 28801 PLYMOUTH RD
Second Line :
City : LIVONIA
State : MI
Zip : 48150-2385
Country : US
Telephone Number : 734-266-2780
Fax Number : 734-466-9615
Provider Business Practice Location Address
First Line : 4420 E DAVISON ST
Second Line :
City : DETROIT
State : MI
Zip : 48212-1744
Country : US
Telephone Number : 313-369-1500
Fax Number : 313-369-1205
Authorized Official
Title or Position : OWNER
Name : ARUNIMA SHIRVASTAVA
Credential : M.D.
Telephone Number : 734-266-2780
Provider Enumeration Date : 02/02/2006
Last Update Date : 08/22/2020

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Directions to “GREAT LAKES FAMILY MEDICAL CENTER PLLC ” Practice Location

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