Organization
GREATER LAKES ANESTHESIA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA CLARK (OFFICE MANAGER)
(973) 777-7879
Entity
Organization
Contact information
Practice address
16100 19 MILE RD, CLINTON TOWNSHIP, MI 48038-1148
(586) 286-0000
(586) 286-0005
Mailing address
999 CLIFTON AVE, CLIFTON, NJ 07013-2711
(973) 777-7879
(973) 777-6738
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
10/12/2009
Last updated
10/12/2009
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