# GREAT LAKES SURGICAL ASSISTANTS, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1558653303
- **Authorized official:** BRANDON E MACKENZIE PA-C (OWNER, PA-C)
- **Authorized official phone:** (586) 246-5125

## Contact information

- **Practice address:** 4550 INVESTMENT DR STE 100, TROY, MI 48098-6334
- **Practice address phone:** (248) 265-4600
- **Mailing address:** 47120 LAND ST, CHESTERFIELD, MI 48047-5142
- **Mailing address phone:** (586) 246-5125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | D5298K | MI | Yes |

## Other

- **Enumeration date:** 05/12/2011
- **Last updated:** 07/21/2011