Organization
GREAT LAKES NEUROSURGICAL ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA SANTOS (EXECUTIVE DIRECTOR)
(616) 242-7042
Entity
Organization
Contact information
Practice address
3350 EAGLE PARK DR NE STE 102, GRAND RAPIDS, MI 49525-4570
(616) 454-3465
(616) 454-9004
Mailing address
3350 EAGLE PARK DR NE STE 102, GRAND RAPIDS, MI 49525-4570
(616) 454-3465
(616) 454-9004
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D11057
BLUE CROSS AND BLUE SHIELD OF MICHIGAN
MI
05
—
1366590929
—
MI
Enumeration date
06/26/2017
Last updated
02/24/2025
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