# GREATER LAKES AMBULATORY SURGICAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Greater Lakes Ambulatory Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679717466
- **Authorized official:** ALLISON ANITA BRYNAERT RN, BSN, RNFA (ADMINISTRATOR/DIRECTOR)
- **Authorized official phone:** (586) 286-0000

## Contact information

- **Practice address:** 16100 19 MILE RD, SUITE 100, CLINTON TOWNSHIP, MI 48038-1148
- **Practice address phone:** (586) 286-0000
- **Practice address fax:** (586) 286-0005
- **Mailing address:** 16100 19 MILE RD, SUITE 100, CLINTON TOWNSHIP, MI 48038-1148
- **Mailing address phone:** (586) 286-0000
- **Mailing address fax:** (586) 286-0005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 506836 | MI | Yes |

## Other

- **Enumeration date:** 04/24/2009
- **Last updated:** 12/28/2016