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Organization
GREAT LAKES IN-HOME CLINICIAN SERVICES INC
Active
Organization
GREAT LAKES IN-HOME CLINICIAN SERVICES INC
Active
Other names
Elite Medical Services, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAVITA SURYAVANSHI O.T. (PRESIDENT)
(810) 245-9400
Entity
Organization
Contact information
Practice address
124 S STATE RD, DAVISON, MI 48423-1347
(810) 664-7040
(810) 245-9080
Mailing address
404 W NEPESSING ST, LAPEER, MI 48446-2150
(810) 664-7040
(810) 245-9080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/24/2009
Last updated
05/21/2010
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