# GREAT LAKES SPINE SPORTS & PAIN, PLLC

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

## Provider details

- **NPI number:** 1780691808
- **Authorized official:** BACHU ABRAHAM M.D. (PRESIDENT)
- **Authorized official phone:** (989) 772-3800

## Contact information

- **Practice address:** 4676 E BROOMFIELD RD STE A, MT PLEASANT, MI 48858-9192
- **Practice address phone:** (989) 772-3800
- **Practice address fax:** (840) 626-4066
- **Mailing address:** PO BOX 87, CADILLAC, MI 49601-0087
- **Mailing address phone:** (231) 775-6076
- **Mailing address fax:** (231) 775-0027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/02/2006
- **Last updated:** 10/03/2007