Great Lakes Physicians of Redford,p.l.l.c.

NPI #1063682730 in Redford, Michigan

Provider Information

NPI Number: 1063682730
Entity Type: Organization
Organization Name: Great Lakes Physicians of Redford,p.l.l.c.
Primary Specialty: Internal Medicine
Enumeration Date: Mar 9, 2008
Last Updated: Mar 9, 2008

Practice Location

Address: 25321 5 MILE RD
Address 2: SUITE # 1
City: Redford
State: Michigan
ZIP Code: 48239-3700
Phone: (313) 538-1800

Authorized Official

Name: DR. MUSTAK Y VAID, M.D.
Title: SOLO OWNER
Phone: (248) 996-8777

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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