Organization
GREAT LAKES MEDICAL, P.C.
Active
Other names
Great Lakes Urgent Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WAYNE MACAULEY MEDICAL DOCTOR (OWNER)
(517) 449-2452
Entity
Organization
Contact information
Practice address
5511 W US HIGHWAY 10, SUITE A, LUDINGTON, MI 49431-2455
(231) 843-1553
Mailing address
5511 W US HIGHWAY 10, SUITE A, LUDINGTON, MI 49431-2455
(231) 843-1553
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
04411G
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04411G
MI STATE
MI
Enumeration date
05/13/2013
Last updated
07/15/2013
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