Organization
GREAT LAKES NEUROMONITORING, PLLC
Active
Organization
GREAT LAKES NEUROMONITORING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIZETTE MORIN (MDMS NPI COMPLIANCE OFFICER)
(210) 598-2801
Entity
Organization
Contact information
Practice address
5119 HIGHLAND RD, (M-59) #389, WATERFORD, MI 48327-1915
(248) 309-6631
Mailing address
5119 HIGHLAND RD, (M-59) #389, WATERFORD, MI 48327-1915
(248) 309-6631
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
Primary
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Enumeration date
12/07/2017
Last updated
12/07/2017
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