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Organization
GREAT LAKES MEDICINE, PLC
Active
Organization
GREAT LAKES MEDICINE, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRASHANT S PATEL MD (PARTNER)
(586) 731-8400
Entity
Organization
Contact information
Practice address
50505 SCHOENHERR RD, STE 340, SHELBY TOWNSHIP, MI 48315-3140
(586) 731-8400
(586) 731-8406
Mailing address
1746 MOMENTUM PL, CHICAGO, IL 60689-5317
(586) 731-8400
(586) 731-8406
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
207R00000X
MI
208M00000X
Hospitalist Physician
Primary
208M00000X
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E03034
BCBS
MI
01
—
DE1755
RR MEDICARE
MI
Enumeration date
07/04/2006
Last updated
11/05/2012
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