National Provider Identifier Database

GREAT LAKES PHYSICIAN PC
Urology

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.


Contact Information

GREAT LAKES PHYSICIAN, PC
3085 HARLEM RD
SUITE 350
CHEEKTOWAGA, NY14225-2591
Phone: 716-844-5000
Fax: 716-844-5050
Website:
Specialty Taxonomy Code
* Urology 208800000X
Clinical Pathology/Laboratory Medicine 207ZP0105X
Radiation Oncology 2085R0001X

* Indicates primary specialty

NPI Profile & details for GREAT LAKES PHYSICIAN, PC

NPI Number 1720045792
Legal business name
LBN
GREAT LAKES PHYSICIAN, PC
Authorized official K CHEVLI - (MANAGING PHYSICIAN)
Entity Organization
Organization subpart No
Enumeration date 04/26/2006
Last updated 04/25/2017 - About 9 years ago
Sole proprietor1 Not specified
Identifiers
  • NY Medicaid: 03869087

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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