MEDICARE: GREAT LAKES MEDICAL EQUIPMENT CORP

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

General Provider Information

NPI Number	:	1770579435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES MEDICAL EQUIPMENT CORP

Provider Business Mailing Address
First Line	:	PO BOX 9681
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46361-9681
Country	:	US
Telephone Number	:	219-873-4556
Fax Number	:	219-861-0556

Provider Business Practice Location Address
First Line	:	8485 W US HIGHWAY 20
Second Line	:	STE B
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-7628
Country	:	US
Telephone Number	:	219-861-0555
Fax Number	:	219-861-0556

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRUCE WEILER
Credential	:
Telephone Number	:	219-873-4556

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	08/22/2020

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