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
Mailing address
3350 EAGLE PARK DR NE STE 102, GRAND RAPIDS, MI 49525-4570
(616) 454-3465
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
LH029420
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225119027
NPI
MI
01
—
1245311059
NPI
MI
01
—
1326144049
NPI
MI
01
—
1497836282
NPI
MI
01
—
1659452472
NPI
MI
01
—
1770664583
NPI
MI
Enumeration date
01/08/2007
Last updated
10/24/2023
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