# GREAT LAKES PAIN SPECIALISTS, LLC

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

## Provider details

- **NPI number:** 1649401258
- **Authorized official:** DR. TIMOTHY STAACKE M.D. (PARTNER)
- **Authorized official phone:** (262) 787-4026

## Contact information

- **Practice address:** 8153 S 27TH ST, FRANKLIN, WI 53132-7012
- **Practice address phone:** (414) 761-1802
- **Mailing address:** 225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4257
- **Mailing address phone:** (262) 787-4026

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2009
- **Last updated:** 07/30/2009