Organization
GREAT LAKES DIGESTIVE HEALTH ASSC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA STONER (ADMINISTRATOR)
(231) 487-2391
Entity
Organization
Contact information
Practice address
560 W MITCHELL ST, STE M40, PETOSKEY, MI 49770-2278
(231) 487-2391
(231) 487-6513
Mailing address
560 W MITCHELL ST, STE M40, PETOSKEY, MI 49770-2278
(231) 487-2391
(231) 487-6513
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
4301091670
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285822387
—
MI
Enumeration date
10/15/2007
Last updated
12/20/2011
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