Organization
GREAT LAKES MEDICAL CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DAWN RENEE SCHRECKENGUST PA-C (PRESIDENT)
(269) 925-8386
Entity
Organization
Contact information
Practice address
1850 PIPESTONE RD, SUITE 102-B, BENTON HARBOR, MI 49022-2304
(269) 925-8386
(269) 925-4085
Mailing address
1850 PIPESTONE RD, SUITE 102-B, BENTON HARBOR, MI 49022-2304
(269) 925-8386
(269) 925-4085
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
5601002947
MI
Other
Enumeration date
03/30/2009
Last updated
03/30/2009
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