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Contact Information

GREAT LAKES SURGICAL ASSISTANTS, PLLC
4550 INVESTMENT DR STE 100
TROY, MI48098-6334
 Phone: 248-265-4600
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for GREAT LAKES SURGICAL ASSISTANTS, PLLC

NPI Number 1558653303
LBN Legal business name GREAT LAKES SURGICAL ASSISTANTS, PLLC
Authorized official BRANDON MACKENZIE - (OWNER, PA-C)
Entity Organization
Organization subpart 1 No
Enumeration date 05/12/2011
Last updated 07/21/2011 - About 15 years ago
Identifiers
MI License # D5298K
MI Other 0N33470042 MEDICARE ID-TYPE UNSPECIFIED
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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