# LAKES OBGYN SPECIALIST

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MERCY HEALTH PARTNERS
- **Other names:** Trinity Health Medical Group Obstetrics & Gynecology - Lake Village
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1548570062
- **Legal business name:** MERCY HEALTH PARTNERS
- **Authorized official:** MICHAEL GUSHO (CHIEF FINANCIAL OFFICE)
- **Authorized official phone:** (734) 398-0642

## Contact information

- **Practice address:** 6401 PRAIRIE ST STE 1700, NORTON SHORES, MI 49444-7843
- **Practice address phone:** (231) 672-7939
- **Mailing address:** PO BOX 776982, CHICAGO, IL 60677-6982
- **Mailing address phone:** (800) 494-5797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 367A00000X | Advanced Practice Midwife | — | NULL | — |
| 367A00000X | Advanced Practice Midwife | — | — | — |

## Other

- **Enumeration date:** 10/18/2010
- **Last updated:** 03/05/2026