Organization
GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL SEAMUS BUGGY (PRESIDENT)
(414) 828-9256
Entity
Organization
Contact information
Practice address
1670 MILLER PARK WAY, WEST MILWAUKEE, WI 53214-3604
(414) 897-8380
(262) 436-1711
Mailing address
1670 MILLER PARK WAY, WEST MILWAUKEE, WI 53214-3604
(414) 897-8380
(262) 436-1711
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100063060
—
WI
Enumeration date
04/06/2016
Last updated
03/25/2024
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