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NPI Code Detail

MEDICARE: GREAT LAKES ORTHOPAEDIC CENTER, P.C.

MEDICARE: GREAT LAKES ORTHOPAEDIC CENTER, P.C.
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
1332B00000XDurable Medical Equipment & Medical Supplies
2335E00000XProsthetic/Orthotic Supplier
3207X00000XOrthopaedic Surgery Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200B811700OTHERMIBLUE CROSS BLUE SHIELD GROUP ID #

General Provider Information

NPI Number : 1952323453
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT LAKES ORTHOPAEDIC CENTER, P.C.
Provider Business Mailing Address
First Line : 4045 W ROYAL DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-8965
Country : US
Telephone Number : 231-935-0900
Fax Number : 231-935-0308
Provider Business Practice Location Address
First Line : 4045 W ROYAL DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-8965
Country : US
Telephone Number : 231-935-0900
Fax Number : 231-935-0308
Authorized Official
Title or Position : ADMINISTRATOR
Name : CHRISSY DURGA
Credential :
Telephone Number : 231-929-5734
Provider Enumeration Date : 07/24/2006
Last Update Date : 10/22/2020

Similar Medicare Providers

1164353983 — MYA EISENGA PTA
Practice Location Address:
4045 W ROYAL DR
TRAVERSE CITY, MI
49684-8965
Practice Phone: 231-935-0900
Practice Fax: 833-471-4026
1336141704 — DR. JEFF PHILIP BURKE PT
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TRAVERSE CITY, MI
49684-8965
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Practice Fax: 231-935-0308
1306835087 — RACHEL ANN DECKER APRN
Practice Location Address:
4045 W ROYAL DR
TRAVERSE CITY, MI
49684-8965
Practice Phone: 231-935-0900
Practice Fax: 833-471-4026
1497725410 — DR. LUANN K LABIAN MD
Practice Location Address:
4020 W ROYAL DR
TRAVERSE CITY, MI
49684-8965
Practice Phone: 231-421-8099
Practice Fax: 231-421-8599
1770505638 — AMY P KUDARY P.A.
Practice Location Address:
4045 W ROYAL DR
TRAVERSE CITY, MI
49684-8965
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Practice Fax: 230-935-0308
1649291519 — DR. EDWARD J BROPHY D.O.
Practice Location Address:
4045 W ROYAL DR
TRAVERSE CITY, MI
49684-8965
Practice Phone: 231-935-0900
Practice Fax: 231-935-0308

Directions to “GREAT LAKES ORTHOPAEDIC CENTER, P.C. ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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