Organization
GREAT LAKES ORTHOPAEDIC CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISSY DURGA (ADMINISTRATOR)
(231) 929-5734
Entity
Organization
Contact information
Practice address
4045 W ROYAL DR, TRAVERSE CITY, MI 49684-8965
(231) 935-0900
(231) 935-0308
Mailing address
4045 W ROYAL DR, TRAVERSE CITY, MI 49684-8965
(231) 935-0900
(231) 935-0308
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200B811700
BLUE CROSS BLUE SHIELD GROUP ID #
MI
Enumeration date
07/24/2006
Last updated
10/22/2020
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