# BELLEVUE PROFESSIONAL SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Great lakes Physicians
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063481737
- **Authorized official:** TIM BUIT (CEO)
- **Authorized official phone:** (419) 483-4040

## Contact information

- **Practice address:** 1400 W MAIN ST, BLDG 1, SUITE A, BELLEVUE, OH 44811-9429
- **Practice address phone:** (419) 483-2494
- **Practice address fax:** (419) 483-3224
- **Mailing address:** PO BOX 638775, CINCINNATI, OH 45263-8775
- **Mailing address phone:** (800) 514-4390
- **Mailing address fax:** (440) 808-3675

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 34012014 | OH | — |
| 207Q00000X | Family Medicine Physician | 35090068 | OH | — |
| 207V00000X | Obstetrics & Gynecology Physician | 34009034 | OH | — |
| 207V00000X | Obstetrics & Gynecology Physician | 35068821 | OH | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | 35127940 | OH | — |
| 207X00000X | Orthopaedic Surgery Physician | 34006462 | OH | — |

## Other

- **Enumeration date:** 03/15/2006
- **Last updated:** 10/23/2023