Organization
GREAT LAKES PEDIATRIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETH ILEEN CHARLES (PRACTICE MANAGER)
(517) 887-3000
Entity
Organization
Contact information
Practice address
3400 PINETREE RD, STE 102, LANSING, MI 48911-4286
(517) 887-3000
Mailing address
3400 PINETREE RD, STE 102, LANSING, MI 48911-4286
(517) 887-3000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301049233
MI
208000000X
Pediatrics Physician
4301063626
MI
208000000X
Pediatrics Physician
4301078945
MI
208000000X
Pediatrics Physician
4301086445
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144338443
NPI
MI
01
—
1144338450
NPI
MI
01
—
1730297045
NPI
MI
01
—
1831309921
NPI
MI
05
—
3069367
—
MI
05
—
3080275
—
MI
05
—
4366885
—
MI
Enumeration date
10/01/2009
Last updated
10/01/2009
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