Organization
GREAT LAKES MEDICAL, P,C,
Active
Other names
GLADWIN URGENT CARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WAYNE MACAULEY M.D. (OWNER)
(517) 449-2452
Entity
Organization
Contact information
Practice address
1277 E CEDAR AVE, SUITE A, GLADWIN, MI 48624-7004
(989) 426-1100
Mailing address
1277 E CEDAR AVE, SUITE A, GLADWIN, MI 48624-7004
(989) 426-1100
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
04411G
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04411G
STATE OF MICHIGAN ID
MI
Enumeration date
05/13/2013
Last updated
07/15/2013
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