Great Lakes Cardiovascular Thoracic Surgery, PLC
Great Lakes Cardiovascular Thoracic Surgery, PLC provides Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician services in Portage, Michigan. Licensed in Michigan. Registered with an NPI since 2006.
- Licensed in
- MI
- In the registry since
- 2006
Practice location Address checks out
7901 S 12th St Ste 201Portage, MI 49024-3831 Not confirmed with CMS for 18 years — call before visiting
Phone: (269) 372-8687
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician (primary) | Taxonomy 208G00000X · Licence 5101009076 (MI) |
|---|
Record details
| NPI number | 1487760427 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | George Mack — President · (269) 372-8687 |
| Other names | Great Lakes Vein Center |
| NPI enumerated | August 22, 2006 |
| Last updated in NPPES | November 13, 2007 |
| Mailing address | 7901 S 12th St, Suite 201, Portage, MI 49024-3831 |
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