Provider Demographics
NPI:1851090815
Name:GREAT LAKES CENTER FOR PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:GREAT LAKES CENTER FOR PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-890-4025
Mailing Address - Street 1:2578 MCLEOD DR N
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2859
Mailing Address - Country:US
Mailing Address - Phone:989-497-3157
Mailing Address - Fax:989-497-3158
Practice Address - Street 1:2578 MCLEOD DR N
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2859
Practice Address - Country:US
Practice Address - Phone:989-497-3157
Practice Address - Fax:989-497-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty