Great Lakes Physicians Pc | |
36180 Five Mile Road Livonia MI 48154 | |
(734) 591-7666 | |
(734) 591-2426 |
Full Name | Great Lakes Physicians Pc |
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Speciality | Internal Medicine |
Location | 36180 Five Mile Road, Livonia, Michigan |
Authorized Official Name and Position | Jayshree Desai (OWNER) |
Authorized Official Contact | 7345917666 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Great Lakes Physicians Pc 36180 Five Mile Road Livonia MI 48154 Ph: (734) 591-7666 | Great Lakes Physicians Pc 36180 Five Mile Road Livonia MI 48154 Ph: (734) 591-7666 |
NPI Number | 1164591053 |
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Provider Enumeration Date | 11/07/2006 |
Last Update Date | 09/28/2012 |
Medicare PECOS PAC ID | 1355341223 |
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Medicare Enrollment ID | O20061228000359 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164591053 | NPI | - | NPPES |
3323140 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Jayshree M Desai |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1396752283 PECOS PAC ID: 9931105426 Enrollment ID: I20061005000391 |
Provider Name | Surendra Kelwala |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1558475517 PECOS PAC ID: 1052318748 Enrollment ID: I20061020000452 |
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