| Organization Name: | GREAT LAKES AMBULATORY SURGERY CENTER |
| NPI Number: | 1023498219 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EMAD AZMY MIKHAIL (OWNER) |
| Mailing Address: | 9002 Mentor Ave Ste B Mentor |
| State: | OH US |
| Postal Code: | 440606302 |
| Phone Number: | 4402830244 |
| Fax Number: | 4402830247 |
| NPI Enumeration Date: | 06/03/2015 |
| NPI Last Update Date: | 06/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 35-075570 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |