Organization
GREAT LAKES ORTHOPAEDICS
Active
Organization
GREAT LAKES ORTHOPAEDICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY E LAWLEY D.O. (PRESIDENT)
(734) 422-8400
Entity
Organization
Contact information
Practice address
6255 INKSTER RD, STE 103, GARDEN CITY, MI 48135-2577
(734) 422-8400
Mailing address
6255 INKSTER RD, STE 103, GARDEN CITY, MI 48135-2577
(734) 422-8400
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H21975
BCBSM
MI
Enumeration date
10/04/2006
Last updated
03/18/2013
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