Organization
GREAT LAKES DIALYSIS, L.L.C.
Active
Other names
Dialysis Care Center Great Lakes East
Organization subpart
No
Provider details
NPI number
Authorized official
MORUFU OLATUNJI ALAUSA MD (AUTHORIZED OFFICIAL / CMO)
(815) 741-6830
Entity
Organization
Contact information
Practice address
14614 KERCHEVAL ST, DETROIT, MI 48215-2814
(313) 308-4200
(313) 332-0334
Mailing address
PO BOX 428, LOCKPORT, IL 60441-6428
(815) 714-7170
(630) 672-4980
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
4301072901
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D1011980
CLIA#
MI
Enumeration date
08/02/2006
Last updated
04/07/2025
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