| Great Lakes Family Medical Center Pllc | |
|
4420 E Davison St Detroit MI 48212-1744 | |
| (313) 369-1500 | |
| (313) 369-1205 |
| Full Name | Great Lakes Family Medical Center Pllc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 4420 E Davison St, Detroit, Michigan |
| Authorized Official Name and Position | Amitabh Paharia (OWNER) |
| Authorized Official Contact | 3133691500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Family Medical Center Pllc 4420 E Davison St Detroit MI 48212-1744 Ph: (313) 369-1500 | Great Lakes Family Medical Center Pllc 4420 E Davison St Detroit MI 48212-1744 Ph: (313) 369-1500 |
| NPI Number | 1982881025 |
|---|---|
| Provider Enumeration Date | 01/30/2008 |
| Last Update Date | 09/04/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982881025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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