Organization
GREEN LAKE MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LEE MOORHEAD (PRESIDENT)
(313) 882-3900
Entity
Organization
Contact information
Practice address
93 KERCHEVAL AVE, GROSSE POINTE FARMS, MI 48236-3600
(313) 882-3900
(313) 882-3947
Mailing address
18530 MACK AVE STE 411, GROSSE POINTE FARMS, MI 48236-3254
(313) 882-3900
(313) 882-3947
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3141989
—
MI
Enumeration date
05/02/2007
Last updated
07/21/2022
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