Organization
GREAT LAKES REGENERATIVE MEDICINE, PLLC
Active
Organization
GREAT LAKES REGENERATIVE MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J BASAK DO (CLINIC DIRECTOR)
(248) 829-0385
Entity
Organization
Contact information
Practice address
2251 N SQUIRREL RD STE 206, AUBURN HILLS, MI 48326-4602
(248) 829-0385
Mailing address
148 GOLF CREST DR, ACWORTH, GA 30101-5968
(248) 829-0239
(678) 574-5605
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
01/03/2020
Last updated
02/27/2020
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