Organization
GREAT LAKES SURGICAL CENTER ANESTHESIA, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN KLEINHOMER M.D. (AUTHORIZED REPRESENTATIVE)
(248) 223-9945
Entity
Organization
Contact information
Practice address
26051 LAHSER RD, SOUTHFIELD, MI 48034-2601
(248) 223-9945
Mailing address
255 W MICHIGAN AVE, JACKSON, MI 49201-2218
(517) 787-6440
(517) 787-4146
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
06/13/2006
Last updated
09/19/2007
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