Organization
GREAT LAKES GASTROENTEROLOGY CONSULTANTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUDHAKAR N. PANGULUR M.D. (PRESIDENT)
(419) 696-5555
Entity
Organization
Contact information
Practice address
2702 NAVARRE AVE, SUITE 106, OREGON, OH 43616-3223
(419) 696-5555
(419) 696-8499
Mailing address
2702 NAVARRE AVE, SUITE 106, OREGON, OH 43616-3223
(419) 696-5555
(419) 696-8499
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2286262
—
OH
Enumeration date
01/03/2007
Last updated
05/09/2008
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