GREAT LAKES GASTROENTEROLOGY, LLC (NPI# 1144350521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144350521 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES GASTROENTEROLOGY, LLC |
| Other Organization Name | KEITH FRIEDENBERG MD LLC |
| Practice Address |
8877 Mentor Ave Mentor OH 44060-6211 |
| Practice Telephone | 4402051225 |
| Practice Fax Number | 4402051275 |
| Mailing Telephone | 4402051225 |
| Mailing Fax Number | 4402051275 |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | DR. KEITH A FRIEDENBERG (OWNER) |
| Authorized Official Telephone | 4402051225 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| Y | 174400000X | Specialist | OH | Other Service Providers |
| Other Name | Type Code |
|---|---|
| Keith Friedenberg MD LLC | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9485 Mentor Ave, Suite 105, Mentor, OH 440604597 | 4402051225 | 4402051275 |
| 36100 Euclid Ave Ste 490, Willoughby, OH 440944488 | 4402051225 | 4402051275 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | GREAT LAKES GASTROENTEROLOGY, LLC | 9485 Mentor Ave Ste 105, Mentor, OH 44060-8722 |
| Street Address |
8877 MENTOR AVE |
| City | MENTOR |
| State | OH |
| Zip Code | 44060-6211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306844980 | Sayed S Khatami | Internal Medicine | 8877 Mentor Ave, Mentor, OH 44060-6211 | 2005-07-08 |
| 1215586698 | Holly Kathleen Hutton | Nurse Practitioner | 8877 Mentor Ave, Mentor, OH 44060-6211 | 2019-09-09 |
| 1700157450 | Keyur P Parikh | Internal Medicine | 8877 Mentor Ave, Mentor, OH 44060-6211 | 2012-01-25 |
| 1235237090 | Don E Brinberg | Internal Medicine | 8877 Mentor Ave, Mentor, OH 44060-6211 | 2006-09-20 |
| 1104928043 | Keith Alan Friedenberg | Internal Medicine | 8877 Mentor Ave, Mentor, OH 44060-6211 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093364143 | Pamela Adams | Technician | 6079 Center St, Mentor, OH 44060 | 2019-09-10 |
| 1255800298 | Brittani Joy Lumpkin | Community/Behavioral Health | 9220 Mentor Road., Mentor, OH 44060 | 2018-11-20 |
| 1043726763 | Sharon Bollinger | Counselor | 7232 Tyler Blvd., Mentor, OH 44060 | 2017-12-18 |
| 1255863635 | Mentor Health and Rehabilitation Center, Inc. | Skilled Nursing Facility | 8151 Norton Pkwy, Mentor, OH 44060 | 2017-04-03 |
| 1144695933 | Kirsten Lorek | Specialist/Technologist | 8400 Paddock Ct, Mentor, OH 44060 | 2015-12-06 |
| 1346638848 | Darlean Williams | Licensed Practical Nurse | 6477 Center Street, Mentor High School, Mentor, OH 44060 | 2015-01-06 |
| 1316357130 | Kathryn Arnette Romo | Speech-Language Pathologist | 6451 Center Street, Mentor Exempted Village Schools, Mentor, OH 44060 | 2014-05-01 |
| 1730599705 | Marianne. P. Kostiha | Registered Nurse | 6451 Center St., Mentor Public Schools, Mentor, OH 44060 | 2014-04-30 |
| 1558788190 | Jeanne Marie Markusic | Physical Therapist | 7687 Ellington Pl, Mentor, OH 44060 | 2014-03-20 |
| 1477979391 | Center for Advanced Vein Care LLC | Emergency Medicine | 7200 Mentor Avenue, Mentor, OH 44060 | 2014-03-17 |
| Find all providers in zip 44060 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497905533 | Janet M. Blanchard, M.d. Ltd. | Specialist | 6990 Lindsay Dr Ste 5, Mentor, OH 44060-4981 | 2008-09-25 |
| 1720488497 | Bradley Havelka | Specialist | 6477 Center St, Mentor, OH 44060-4109 | 2014-08-29 |
| 1114358223 | Vanessa Patterson | Specialist | 7519 Mentor Ave, Mentor, OH 44060-5434 | 2013-11-29 |
| 1427355890 | Ohio Mobile X-ray Inc | Specialist | 7547 Mentor Ave, Ste. 100, Mentor, OH 44060-5438 | 2011-02-22 |
| 1902125412 | Jennifer Margaret Reider | Specialist | 9853 Johnnycake Ridge Rd, Ste 306a, Mentor, OH 44060-6700 | 2010-05-24 |
| 1023280211 | Joseph A. Golish, Md, Inc. | Specialist | 7676 Reynolds Rd, Mentor, OH 44060-5127 | 2008-03-27 |
| 1992924609 | Oaktree Clinic, Inc. | Specialist | 9485 Mentor Ave, Suite # 214, Mentor, OH 44060-4597 | 2007-04-24 |
| 1801929849 | Clive Leonard Sinoff | Specialist | 7350 Industrial Park Blvd, Mentor, OH 44060-5318 | 2007-03-13 |
| 1932261963 | Paul F Vanek Jr M D Inc | Specialist | 9485 Mentor Ave, Suite 100, Mentor, OH 44060-4597 | 2006-12-15 |
| 1730256967 | Paul Frank Vanek Jr. | Specialist | 9485 Mentor Ave, Suite 100, Mentor, OH 44060-4597 | 2006-11-30 |
| Find all providers in MENTOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.