GREAT LAKES CARDIOVASCULAR THORACIC SURGERY, PLC (NPI# 1487760427) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487760427 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES CARDIOVASCULAR THORACIC SURGERY, PLC |
| Other Organization Name | GREAT LAKES VEIN CENTER |
| Practice Address |
7901 S 12th St Suite 201 Portage MI 49024-3831 |
| Practice Telephone | 2693728687 |
| Mailing Telephone | 2693728687 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-11-13 |
| Authorized Official Name | DR. GEORGE JOSEPH MACK (PRESIDENT) |
| Authorized Official Telephone | 2693728687 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5101009076 | MI | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| great lakes vein center | Doing Business As Name - Organization |
| Street Address |
7901 S 12TH ST SUITE 201 |
| City | PORTAGE |
| State | MI |
| Zip Code | 49024-3831 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538593009 | Kimberly Carol Clark | Specialist | 7901 S 12th St, Suite 200, Portage, MI 49024-3831 | 2013-09-02 |
| 1669756912 | Kalamazoo Foot and Ankle Specialists, Plc | Podiatrist | 7901 S 12th St, Suite 101, Portage, MI 49024-3831 | 2011-10-05 |
| 1639464894 | Kelly Renee Campbell | Occupational Therapist | 7901 S 12th St, Suite #200, Portage, MI 49024-3831 | 2011-06-16 |
| 1144519133 | Jonathan Nykamp | Nurse Practitioner | 7901 S 12th St, Portage, MI 49024-3831 | 2011-03-31 |
| 1689818486 | Kimberly Clawson | Plastic Surgery | 7901 S 12th St, Portage, MI 49024 | 2009-04-23 |
| 1184886111 | Michael P Maskill | Podiatrist | 7901 S 12th St, Portage, MI 49024-3831 | 2008-07-01 |
| 1588756340 | Bryan Dale Visser | Physical Medicine & Rehabilitation | 7901 S 12th St, Suite #200, Portage, MI 49024-3831 | 2006-09-29 |
| 1609968247 | Alfonso Emanuel F Rodriguez | Physical Therapist | 7901 S 12th St, Suite #200, Portage, MI 49024-3831 | 2006-09-29 |
| 1356384275 | George Joseph Mack | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 7901 S 12th St, Ste. 201, Portage, MI 49024-3831 | 2006-06-14 |
| 1942247176 | Sports Medicine & Joint Care of West Michigan, Plc | Orthopaedic Surgery | 7901 S 12th St, Suite 101, Portage, MI 49024-3831 | 2006-05-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134774524 | Antonio Richard Barron | Physician Assistant | 5717 Oakland Dr Ste A, Portage, MI 49024 | 2019-08-03 |
| 1699279240 | Julie Lynn Griffin | Specialist/Technologist | Portage Northern High School, 1000 Idaho Ave, Portage, MI 49024 | 2018-03-20 |
| 1194255711 | Brittany Lynn Finkler | Audiologist | 576 Romence Rd Ste 121, Portage, MI 49024 | 2017-06-15 |
| 1164881207 | Family & Children Services, Inc. | Clinic/Center | 1302 W Milham Ave, Portage, MI 49024 | 2016-02-17 |
| 1497127716 | Huber Counseling, LLC | Counselor | 1591 West Centre Ave, Suite 102, Portage, MI 49024 | 2015-10-26 |
| 1659757466 | Marie Porter | Rehabilitation Practitioner | 5724 Alten St, Portage, MI 49024 | 2015-08-04 |
| 1063824860 | George Hughes | General Practice | 6630 Sunburst Dr, Portage, MI 49024 | 2014-05-28 |
| 1922358407 | Kimberly Lynn Ellrich | Speech-Language Pathologist | Storypoint, 3951 W Milham Ave, Portage, MI 49024 | 2012-09-12 |
| 1942593744 | Shamika Hall, Ph.d. & Associates, Pllc | Community/Behavioral Health | 7901 S. 12th St., Suite 201, Portage, MI 49024 | 2011-05-26 |
| 1306142815 | Jody Lynn Wrathall | Dentist | 3020 Old Centre Rd, Portage, MI 49024 | 2011-01-31 |
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| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356384275 | George Joseph Mack | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 7901 S 12th St, Ste. 201, Portage, MI 49024-3831 | 2006-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710479191 | United Surgical Associates Pllc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2150 Association Dr, Okemos, MI 48864-4909 | 2018-06-01 |
| 1841719531 | Liberty Cardiolvascular Group Pllc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5250 Auto Club Dr Ste 300l, Dearborn, MI 48126-2619 | 2017-09-13 |
| 1710411293 | Abdul Hassan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 11 Chateaux Du Lac, Fenton, MI 48430 | 2017-04-12 |
| 1871982249 | Michigan Heart Lung and Vein Surgery | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2757 Leonard Ne, Ste 200, Grand Rapids, MI 49525-5807 | 2015-01-22 |
| 1154767382 | Michigan Thoracic Institute, PC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6640 Kings Ct, West Bloomfield, MI 48322-2779 | 2013-05-15 |
| 1679815898 | Hanna Park | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 100 Michigan St Ne Rm 8830, Grand Rapids, MI 49503 | 2013-03-26 |
| 1760730469 | Hurley Medical Center | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1125 S. Linden Road, Suite 700, Flint, MI 48532-4069 | 2012-08-28 |
| 1245588326 | Bakri Kaakeh | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4701 Towne Centre Rd Ste 301, Saginaw, MI 48604-2800 | 2012-08-21 |
| 1447521554 | Eduardo Arciniegas | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3236 Interlaken St, West Bloomfield, MI 48323-1824 | 2012-01-20 |
| 1629358650 | Steven S. Demos | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3739 Highgate Rd, Norton Shores, MI 49441-5017 | 2011-08-22 |
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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.