GREAT LAKES PAIN CONSULT PLLC (NPI# 1255370094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255370094 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES PAIN CONSULT PLLC |
| Practice Address |
4121 Shrestha Dr Bay City MI 48706 |
| Mailing Address |
61 Commerce Ave Sw Grand Rapids MI 49503-4124 |
| Practice Telephone | 9896866900 |
| Practice Fax Number | 9896866911 |
| Mailing Telephone | 6169400660 |
| Mailing Fax Number | 6169401965 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-06-19 |
| Authorized Official Name | THERON HUGH GROVER (PRESIDENT) |
| Authorized Official Telephone | 9896866911 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS BLUE SHIELD | 050Z901090 | 01 |
| Street Address |
4121 SHRESTHA DR |
| City | BAY CITY |
| State | MI |
| Zip Code | 48706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679552228 | Erik Paul Voogd | Anesthesiology | 4121 Shrestha Dr, Bay City, MI 48706-2171 | 2006-01-12 |
| 1770843427 | Bradley Nathan Witte | Physical Therapist | 4121 Shrestha Dr, Bay City, MI 48706-2171 | 2012-05-29 |
| 1760712673 | Horizon Physical Therapy and Rehabilitation LLC | Physical Therapist | 4121 Shrestha Dr, Bay City, MI 48706-2171 | 2009-12-29 |
| 1548380074 | Krishna Kanth Chalasani | Physical Therapist | 4121 Shrestha Dr, Horizon Physical Therapy & Rehabilitation, Bay City, MI 48706-2171 | 2007-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619574357 | Kalie Keyes | Behavior Technician | 3710 Katalin Ct, Bay City, MI 48706 | 2020-10-06 |
| 1790251049 | Leann Marie Miller | Nurse Practitioner | Visiting Physicians Association, 1484 Straits Drive, Bay City, MI 48706 | 2018-10-15 |
| 1659883676 | Matthew Zamora | Internal Medicine | 4818 S Professional Dr, Bay City, MI 48706 | 2017-10-31 |
| 1376082230 | Deidre Dotson | Social Worker | 1217 S Euclid, Bay City, MI 48706 | 2017-02-13 |
| 1790100717 | Kochar Plc | Internal Medicine | 4817 E. Professional Drive, Bay City, MI 48706 | 2014-02-27 |
| 1992136477 | Janelle Gale Ballard | Music Therapist | 4106 Wilder Rd, Bay City, MI 48706 | 2013-12-09 |
| 1619319084 | Jessica T Jang | Veterinarian | 6015 West Side Saginaw Rd, Bay City, MI 48706 | 2013-07-25 |
| 1427493634 | Cynthia Marie Bordeau | Social Worker | 1217 S. Euclid, Bay City, MI 48706 | 2013-05-01 |
| 1902162746 | Delta Family Clinic South PC | Psychologist | 901 N. Euclid Ave., Bay City, MI 48706 | 2012-04-05 |
| 1669762985 | James Norbert Stachowski | Pharmacist | 3880 Wilder, Bay City, MI 48706 | 2011-04-08 |
| Find all providers in zip 48706 | ||||
| Taxonomy Code | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679552228 | Erik Paul Voogd | Anesthesiology | 4121 Shrestha Dr, Bay City, MI 48706-2171 | 2006-01-12 |
| 1922494269 | Great Lakes Physician Resources Pllc | Anesthesiology | 1900 Columbus Ave, Bay City, MI 48708-6831 | 2015-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629568811 | Flint Pain Specialists Pllc | Anesthesiology | 1345 Willowdale Ct Ste B, Flint, MI 48532-4737 | 2018-05-14 |
| 1548624984 | Ayman Tarabishy Md Pllc | Anesthesiology | 400 Plymouth Rd, F2, Plymouth, MI 48170-1482 | 2016-04-12 |
| 1457733008 | John Sung Ha | Anesthesiology | 325 E Eisenhower Pkwy Ste 310, Ann Arbor, MI 48108-3307 | 2015-06-19 |
| 1841603362 | Clinton Pain and Anesthesia Plc | Anesthesiology | 16100 19 Mile Road, Clinton Township, MI 48038 | 2014-06-03 |
| 1255743738 | Advanced Pain Specialists | Anesthesiology | 18100 Oakwood Blvd Ste 203, Dearborn, MI 48124-4085 | 2014-06-02 |
| 1871931592 | Ihsan Asbahi | Anesthesiology | 1234 S Lapeer Rd, Lake Orion, MI 48360 | 2013-06-05 |
| 1265876403 | Medical Business Consultants, Ltd. | Anesthesiology | 63474 Zabel Shores Rd, Sturgis, MI 49091-9371 | 2013-04-18 |
| 1407198807 | Kevin M. Nemeth | Anesthesiology | 2060 East Paris Ave Se Ste 200, Grand Rapids, MI 49546-6113 | 2013-03-23 |
| 1891054573 | Eduardo Icaza | Anesthesiology | 36622 Five Mile Rd Ste 101, Livonia, MI 48154-1900 | 2012-05-15 |
| 1972884724 | Martin Ilan Noveck | Anesthesiology | 9255 Allen Rd, Clarkston, MI 48348-2726 | 2011-09-07 |
| Find all providers with the same taxonomy | ||||
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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.