Organization
GREAT LAKES CARDIOTHORACIC & VASCULAR SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD E. VAZALES M.D. (PRESIDENT)
(231) 487-9090
Entity
Organization
Contact information
Practice address
2390 MITCHELL PARK DR, SUITE B, PETOSKEY, MI 49770-8965
(231) 487-9090
(231) 487-9191
Mailing address
2390 MITCHELL PARK DR, SUITE B, PETOSKEY, MI 49770-8965
(231) 487-9090
(231) 487-9191
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
780001998
RR MEDICARE
MI
Enumeration date
06/13/2006
Last updated
10/20/2009
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