# GREAT LAKES CARDIOVASCULAR THORACIC SURGERY, PLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** great lakes vein center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487760427
- **Authorized official:** DR. GEORGE JOSEPH MACK D.O. (PRESIDENT)
- **Authorized official phone:** (269) 372-8687

## Contact information

- **Practice address:** 7901 S 12TH ST, SUITE 201, PORTAGE, MI 49024-3831
- **Practice address phone:** (269) 372-8687
- **Mailing address:** 7901 S 12TH ST, SUITE 201, PORTAGE, MI 49024-3831
- **Mailing address phone:** (269) 372-8687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 5101009076 | MI | Yes |

## Other

- **Enumeration date:** 08/22/2006
- **Last updated:** 11/13/2007