Great Lakes Dialysis, L.L.C. in Detroit - End-stage Renal Disease (esrd) Treatment
Great Lakes Dialysis, L.L.C. - NPI 1720095417
Great Lakes Dialysis, L.L.C. is a End-stage Renal Disease (esrd) Treatment in Detroit, Michigan. Great Lakes Dialysis, L.L.C. practices all healthcare services and medical treatments related to End-stage Renal Disease (esrd) Treatment. The NPI Number for Great Lakes Dialysis, L.L.C. is 1720095417. The last update date is 2020-08-22.
Great Lakes Dialysis, L.L.C.'s current location address is 14614 Kercheval St, Detroit, Michigan. You can contact this provider via phone number 3139249670 and fax number 3139249673. The mailing address for Great Lakes Dialysis, L.L.C. is 14614 Kercheval St, Detroit, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Great Lakes Dialysis, L.L.C. |
|---|---|
| Address | 14614 Kercheval St, Detroit, Michigan |
| Phone Number | 3139249670 |
| Fax Number | 3139249673 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PRESIDENT/ |
|---|---|
| Authorized Official Name | Tubie Atakekor Boniface |
| Credentials | M.D. |
| Telephone Number | 3139249670 |
NPI Number Detail
| NPI Number | 1720095417 |
|---|---|
| Provider Enumeration Date | 2006-08-02 |
| Last Updated Date | 2020-08-22 |
Provider Mailing Address Detail
| Address | 14614 Kercheval St |
|---|---|
| City | Detroit |
| State | Michigan (MI) |
| Post Code | 482152814 |
| Phone Number | 3139249670 |
| Fax Number | 3139249673 |
Provider's Primary Taxonomy Detail
| Speciality | End-stage Renal Disease (esrd) Treatment |
|---|---|
| Taxonomy | 261Qe0700X |
| Licence No | 4301072901 |
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Definition: Provides dialysis and other medical care to patients with permanent kidney failure. |
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Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Great Lakes Dialysis, L.L.C. by the Centers for Medicare & Medicaid Services?
The Great Lakes Dialysis, L.L.C. has been issued the NPI (National Provider Identifier) 1720095417, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete physical location address of Great Lakes Dialysis, L.L.C.?
The Great Lakes Dialysis, L.L.C. is physically situated at 14614 Kercheval St, in the city of Detroit, state of MI, with the postal code 482152814.
What is the Great Lakes Dialysis, L.L.C.'s specialty and taxonomy code?
The Great Lakes Dialysis, L.L.C.'s specialty is End-stage Renal Disease (esrd) Treatment, and the corresponding taxonomy code is 261Qe0700X.
On what date did Great Lakes Dialysis, L.L.C. receive its 1720095417 assignment from the Centers for Medicare & Medicaid Services?
The Great Lakes Dialysis, L.L.C. was assigned its 1720095417 on 2006-08-02, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
When was the Great Lakes Dialysis, L.L.C.'s information last updated?
The Great Lakes Dialysis, L.L.C.'s information was last updated on 2020-08-22.
NPI Number: 1902809924
Address: 2400 W Main St, Rock Hill, SC