Organization
GREAT LAKES MEDICAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAZEEN AHMED MD (OWNER)
(989) 891-9000
Entity
Organization
Contact information
Practice address
2110 16TH STREET, STE. 4, BAY CITY, MI 48708
(989) 891-9000
(989) 891-9876
Mailing address
PO BOX 725, STANDISH, MI 48658-0725
(989) 891-9000
(989) 891-9876
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
TA066513
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588986996
—
MI
Enumeration date
02/26/2010
Last updated
03/30/2021
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