Organization
GREAT LAKES MEDICAL ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRAKASH SARVEPALLI M.D. (PRESIDENT)
(989) 427-5320
Entity
Organization
Contact information
Practice address
1021 E. MAIN STREET, EDMORE, MI 48829
(989) 427-5320
(989) 427-8220
Mailing address
1021 E. MAIN STREET, EDMORE, MI 48829
(989) 427-5320
(989) 427-8220
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
MI
207R00000X
Internal Medicine Physician
Primary
—
MI
363A00000X
Physician Assistant
—
MI
363L00000X
Nurse Practitioner
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E91083
BCBSM
MI
Enumeration date
09/20/2006
Last updated
09/28/2023
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