| NPI | 1710202825 |
|---|---|
| Doing Business As | GREAT LAKES PHYSICIANS OF SOUTHFIELD, LLC |
| Entity Type | Organization |
| Authorized Contact | PAUL PETRE Owner 248-223-1500 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2011-03-07 |