Provider Demographics
NPI:1841323755
Name:GREAT LAKES SUGICAL PARTNERS, LTD.
Entity type:Organization
Organization Name:GREAT LAKES SUGICAL PARTNERS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-690-0888
Mailing Address - Street 1:1050 ISAAC STREETS DR
Mailing Address - Street 2:SUITE 131
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3291
Mailing Address - Country:US
Mailing Address - Phone:419-690-0888
Mailing Address - Fax:419-690-8228
Practice Address - Street 1:1050 ISAAC STREETS DR
Practice Address - Street 2:SUITE 131
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3291
Practice Address - Country:US
Practice Address - Phone:419-690-0888
Practice Address - Fax:419-690-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9308431Medicare PIN