Organization
GREAT LAKES SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH M METZ M.D. (MEDICAL DIRECTOR)
(248) 223-9925
Entity
Organization
Contact information
Practice address
26051 LAHSER RD, SOUTHFIELD, MI 48034-2601
(248) 223-9925
(248) 223-9957
Mailing address
26051 LAHSER RD, SOUTHFIELD, MI 48034-2601
(248) 223-9925
(248) 223-9957
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
261QA1903X
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17228
MCARE
MI
01
—
40332
BLUE CROSS PRIMARY
MI
01
—
490F328640
BLUE CROSS SECONDARY
MI
Enumeration date
05/02/2006
Last updated
04/20/2008
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