# GREAT LAKES PAIN CONSULT PLLC

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

## Provider details

- **NPI number:** 1255370094
- **Authorized official:** THERON HUGH GROVER MD (PRESIDENT)
- **Authorized official phone:** (989) 686-6911

## Contact information

- **Practice address:** 4121 SHRESTHA DR, BAY CITY, MI 48706
- **Practice address phone:** (989) 686-6900
- **Practice address fax:** (989) 686-6911
- **Mailing address:** 61 COMMERCE AVE SW, GRAND RAPIDS, MI 49503-4124
- **Mailing address phone:** (616) 940-0660
- **Mailing address fax:** (616) 940-1965

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/06/2006
- **Last updated:** 06/19/2014