| Great Lakes Healthcare, Pllc | |
|
251 E Peck Rd Peck MI 48466-9589 | |
| (810) 378-4900 | |
| (810) 378-4905 |
| Full Name | Great Lakes Healthcare, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 251 E Peck Rd, Peck, Michigan |
| Authorized Official Name and Position | Kenneth Eugene Dambacher (OWNER) |
| Authorized Official Contact | 8103784900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Healthcare, Pllc Po Box 129 Yale MI 48097-0129 Ph: (810) 378-4900 | Great Lakes Healthcare, Pllc 251 E Peck Rd Peck MI 48466-9589 Ph: (810) 378-4900 |
| NPI Number | 1881855328 |
|---|---|
| Provider Enumeration Date | 06/18/2008 |
| Last Update Date | 11/10/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881855328 | NPI | - | NPPES |
| 114469926 | Medicaid | MI | |
| 5670042 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| 08-0G61059-0 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5101008768 (Michigan) | Primary |
Mckenzie Memorial Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 251 E Peck Rd, Peck, MI 48466 Phone: 810-378-4900 Fax: 810-378-4905 |