Organization
GREAT LAKES MEDICAL IMAGING LLC
Active
Organization
GREAT LAKES MEDICAL IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH D PEARSEN MD (MD)
(716) 836-4646
Entity
Organization
Contact information
Practice address
111 N MAPLEMERE RD STE 120, WILLIAMSVILLE, NY 14221-3178
(716) 836-4646
(716) 836-4696
Mailing address
111 N MAPLEMERE RD STE 120, WILLIAMSVILLE, NY 14221-3178
(716) 836-4646
(716) 836-4696
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03428622
—
NY
Enumeration date
01/19/2012
Last updated
08/21/2023
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