Great Lakes In-Home Clinician Services INC

NPI #1467696153 in Davison, Michigan

Provider Information

NPI Number: 1467696153
Entity Type: Organization
Organization Name: Great Lakes In-Home Clinician Services INC
Primary Specialty: Nurse Practitioner
Enumeration Date: Apr 24, 2009
Last Updated: May 21, 2010

Practice Location

Address: 124 S STATE RD
City: Davison
State: Michigan
ZIP Code: 48423-1347
Phone: (810) 664-7040

Authorized Official

Name: MRS. KAVITA SURYAVANSHI, O.T.
Title: PRESIDENT
Phone: (810) 245-9400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X	Primary

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