# GREAT LAKES HOME DOCTORS PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Patient Care Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679705354
- **Authorized official:** DR. AUNDREY LUTSKOVSKY D.O. (OWNER)
- **Authorized official phone:** (313) 978-2343

## Contact information

- **Practice address:** 1160 VILLA CT N, WALLED LAKE, MI 48390-3376
- **Practice address phone:** (313) 978-2343
- **Mailing address:** 1160 VILLA CT N, WALLED LAKE, MI 48390-3376

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/14/2009
- **Last updated:** 04/15/2011