# GREAT LAKES MEDICAL ASSOCIATES, PC

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

## Provider details

- **NPI number:** 1811094295
- **Authorized official:** PRAKASH SARVEPALLI M.D. (PRESIDENT)
- **Authorized official phone:** (989) 427-5320

## Contact information

- **Practice address:** 1021 E. MAIN STREET, EDMORE, MI 48829
- **Practice address phone:** (989) 427-5320
- **Practice address fax:** (989) 427-8220
- **Mailing address:** 1021 E. MAIN STREET, EDMORE, MI 48829
- **Mailing address phone:** (989) 427-5320
- **Mailing address fax:** (989) 427-8220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | MI | — |
| 207R00000X | Internal Medicine Physician | — | MI | Yes |
| 363A00000X | Physician Assistant | — | MI | — |
| 363L00000X | Nurse Practitioner | — | MI | — |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 09/28/2023