Organization
GREAT LAKES CARDIOVASCULAR THORACIC SURGERY, PLC
Active
Other names
great lakes vein center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE JOSEPH MACK D.O. (PRESIDENT)
(269) 372-8687
Entity
Organization
Contact information
Practice address
7901 S 12TH ST, SUITE 201, PORTAGE, MI 49024-3831
(269) 372-8687
Mailing address
7901 S 12TH ST, SUITE 201, PORTAGE, MI 49024-3831
(269) 372-8687
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
5101009076
MI
Other
Enumeration date
08/22/2006
Last updated
11/13/2007
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