Organization
GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.
Active
Parent organization
GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT LAKES ORTHOTICS & MEDICAL SUPPLY, INC.
Authorized official
MICHAEL SEAMUS BUGGY (PRESIDENT)
(414) 828-9256
Entity
Organization
Contact information
Practice address
3900 W BROWN DEER RD STE 140, BROWN DEER, WI 53209-1220
(414) 897-8380
(414) 210-3489
Mailing address
6520 W LAYTON AVE STE 103, GREENFIELD, WI 53220-4500
(414) 897-8380
(414) 210-3489
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/01/2021
Last updated
04/01/2021
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