| NPI | 1225218076 |
|---|---|
| Doing Business As | GREAT LAKES DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | MICHAEL RANDY COHEN Physician/Owner 248-259-7733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5101014034) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2021-06-21 |