# GREAT LAKES PHYSICIANS OF REDFORD,P.L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063682730
- **Authorized official:** DR. MUSTAK Y VAID M.D. (SOLO OWNER)
- **Authorized official phone:** (248) 996-8777

## Contact information

- **Practice address:** 25321 5 MILE RD, SUITE \# 1, REDFORD, MI 48239-3700
- **Practice address phone:** (313) 538-1800
- **Practice address fax:** (313) 538-9082
- **Mailing address:** 23300 PROVIDENCE DR, SUITE \# 104, SOUTHFIELD, MI 48075-3652
- **Mailing address phone:** (248) 996-8777
- **Mailing address fax:** (248) 996-8778

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 1630863 | MI | Yes |

## Other

- **Enumeration date:** 03/09/2008
- **Last updated:** 03/09/2008