# GREAT LAKES CARDIOTHORACIC & VASCULAR SURGERY PLLC

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

## Provider details

- **NPI number:** 1346283116
- **Authorized official:** DR. BRAD E. VAZALES M.D. (PRESIDENT)
- **Authorized official phone:** (231) 487-9090

## Contact information

- **Practice address:** 2390 MITCHELL PARK DR, SUITE B, PETOSKEY, MI 49770-8965
- **Practice address phone:** (231) 487-9090
- **Practice address fax:** (231) 487-9191
- **Mailing address:** 2390 MITCHELL PARK DR, SUITE B, PETOSKEY, MI 49770-8965
- **Mailing address phone:** (231) 487-9090
- **Mailing address fax:** (231) 487-9191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/13/2006
- **Last updated:** 10/20/2009