Organization
GREAT LAKES ORTHOTICS AND MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BUGGY (PRESIDENT)
(262) 227-0346
Entity
Organization
Contact information
Practice address
8633 W GREENFIELD AVE, WEST ALLIS, WI 53214-4362
(262) 361-4389
Mailing address
8633 W GREENFIELD AVE, WEST ALLIS, WI 53214-4362
(262) 361-4389
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
12/30/2013
Last updated
12/30/2013
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