Organization
GREAT LAKES ELECTROPHYSIOLOGICAL TESTING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHYAWAN KUMAR BANSIL PT, PH.D. (PRESIDENT)
(248) 489-1771
Entity
Organization
Contact information
Practice address
28959 AUGUSTA, FARMINGTON HILLS, MI 48331-4822
(248) 489-1771
(248) 489-1771
Mailing address
28959 AUGUSTA, FARMINGTON HILLS, MI 48331-4822
(248) 489-1771
(248) 489-1771
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
01/12/2007
Last updated
08/22/2020
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