| Organization Name: | GREAT LAKES MEDICAL CENTER PLLC |
| NPI Number: | 1588986996 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAZEN AHMED (OWNER) |
| Mailing Address: | 805 W Cedar Ave Standish |
| State: | MI US |
| Postal Code: | 48658 |
| Phone Number: | 9898463545 |
| Fax Number: | 9898463509 |
| NPI Enumeration Date: | 02/26/2010 |
| NPI Last Update Date: | 07/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RG0300X |
| License Number: | TA066513 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Geriatric Medicine |
| Taxonomy Definition: | An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |