| NPI | 1487760427 |
|---|---|
| Doing Business As | GREAT LAKES VEIN CENTER |
| Entity Type | Organization |
| Authorized Contact | GEORGE JOSEPH MACK President 269-372-8687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: MI 5101009076) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-11-13 |