# GREAT LAKES MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GREAT LAKES FOOT & ANKLE CENTERS OF GREATER MILWAUKEE LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1497980759
- **Legal business name:** GREAT LAKES FOOT & ANKLE CENTERS OF GREATER MILWAUKEE LLC
- **Authorized official:** DR. JOHN L BOSTANCHE DPM (DIRECTOR)
- **Authorized official phone:** (262) 657-3668

## Contact information

- **Practice address:** 8153 S 27TH ST, FRANKLIN, WI 53132-7012
- **Practice address phone:** (773) 885-7696
- **Practice address fax:** (773) 409-5710
- **Mailing address:** DEPARTMENT 7917, CAROL STREAM, IL 60122
- **Mailing address phone:** (773) 885-7696
- **Mailing address fax:** (773) 409-5710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/15/2009
- **Last updated:** 03/15/2011