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Organization
GREAT LAKES PHYSICIANS OF SOUTHFIELD,PLLC
Active
Organization
GREAT LAKES PHYSICIANS OF SOUTHFIELD,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL M PETRE MD (OWNER)
(248) 223-1500
Entity
Organization
Contact information
Practice address
23999 NORTHWESTERN HWY, SUITE 110, SOUTHFIELD, MI 48075-2578
(248) 223-1500
(248) 223-9600
Mailing address
23999 NORTHWESTERN HWY, SUITE 110, SOUTHFIELD, MI 48075-2578
(248) 223-1500
(248) 223-9600
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
06/13/2007
Last updated
05/29/2009
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