| Organization Name: | GREAT LAKES SURGERY CENTER LLC |
| NPI Number: | 1003273129 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID N. BROWN (MANAGER MEMBER) |
| Mailing Address: | 2848 Niles Rd Suite B Saint Joseph |
| State: | MI US |
| Postal Code: | 490853352 |
| Phone Number: | 2694283300 |
| Fax Number: | |
| NPI Enumeration Date: | 01/20/2016 |
| NPI Last Update Date: | 01/20/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS0132X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ophthalmologic Surgery |
| Taxonomy Definition: | |