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Organization

GREAT LAKES PLASTIC SURGERY CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. CATHERINE S FRANCIS (MEDICAL BILLER)
(231) 935-0180
Entity
Organization

Contact information

Practice address
5085 ANNA DR, TRAVERSE CITY, MI 49684-9691
(231) 935-0180
(231) 935-0099
Mailing address
5085 ANNA DR, TRAVERSE CITY, MI 49684-9691
(231) 935-0180
(231) 935-0099

Taxonomy

Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1285614032
NPI
MI
01
1437139318
NPI
MI
01
2402810821
BLUE CROSS BLUE SHIELD MI
MI
05
3495242
MI
05
4156180
MI
01
4301067433
STATE LICENSE
MI
01
4704192319
STATE LICENSE
MI
01
5008762590
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
08/09/2007
Last updated
08/18/2009
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