MEDICARE: GREAT LAKES ELECTROPHYSIOLOGICAL TESTING SERVICES

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	174400000X	Specialist

General Provider Information

NPI Number	:	1992855639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES ELECTROPHYSIOLOGICAL TESTING SERVICES

Provider Business Mailing Address
First Line	:	28959 AUGUSTA
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-4822
Country	:	US
Telephone Number	:	248-489-1771
Fax Number	:	248-489-1771

Provider Business Practice Location Address
First Line	:	28959 AUGUSTA
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-4822
Country	:	US
Telephone Number	:	248-489-1771
Fax Number	:	248-489-1771

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHYAWAN KUMAR BANSIL
Credential	:	PT, PH.D.
Telephone Number	:	248-489-1771

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1306933908 — DR. CHYAWAN KUMAR BANSIL PT, PH.D.
Practice Location Address:

28959 AUGUSTA
FARMINGTON HILLS, MI
48331-4822

Practice Phone: 248-299-0030
Practice Fax: 248-444-8339

1639161607 — MICHAEL JOSEPH BERETTA P.T.
Practice Location Address:

4822 GOLDEN FOOTHILL PKWY UNIT 9
EL DORADO HILLS, CA
95762-9829

Practice Phone: 916-941-2440
Practice Fax: 916-941-2450

1093954943 — BERETTA PHYSICAL THERAPY, INC.
Practice Location Address:

4822 GOLDEN FOOTHILL PKWY UNIT 9
EL DORADO HILLS, CA
95762-9829

Practice Phone: 916-941-2440
Practice Fax: 916-941-2450

1841631058 — SASHA GROSSMAN M.S., CCC-SLP
Practice Location Address:

324 S BEVERLY DR # 1126
BEVERLY HILLS, CA
90212-4822

Practice Phone: 323-910-2506
Practice Fax:

1215314331 — DARLENE GIUNTA-ERNST
Practice Location Address:

4822 215TH ST
BAYSIDE HILLS, NY
11364-1331

Practice Phone: 718-229-1225
Practice Fax:

1942972427 — SIMPLY OUR SOLUTIONS
Practice Location Address:

4822 SUMMERHILL DR
COUNTRY CLUB HILLS, IL
60478-2010

Practice Phone: 773-255-9495
Practice Fax:

Directions to “GREAT LAKES ELECTROPHYSIOLOGICAL TESTING SERVICES ” Practice Location

Language	Start Address	Practice Location

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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.