GREAT LAKES SURGICAL ASSISTANTS, PLLC (NPI# 1558653303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558653303 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES SURGICAL ASSISTANTS, PLLC |
| Practice Address |
4550 Investment Dr Ste 100 Troy MI 48098-6334 |
| Mailing Address |
47120 Land St Chesterfield MI 48047-5142 |
| Practice Telephone | 2482654600 |
| Mailing Telephone | 5862465125 |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2011-07-21 |
| Authorized Official Name | BRANDON E MACKENZIE (OWNER, PA-C) |
| Authorized Official Telephone | 5862465125 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
D5298K | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MEDICARE ID-TYPE UNSPECIFIED | 0N33470042 | 01 |
| Street Address |
4550 INVESTMENT DR STE 100 |
| City | TROY |
| State | MI |
| Zip Code | 48098-6334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669588620 | Carol C Richardson | Nurse Anesthetist, Certified Registered | 4550 Investment Dr Ste 100, Troy, MI 48098-6334 | 2006-08-22 |
| 1104003862 | Tara Lynn Kautzer | Nurse Anesthetist, Certified Registered | 4550 Investment Dr Ste 100, Troy, MI 48098-6334 | 2008-01-24 |
| 1851407977 | Theresa M Delpup-smith | Nurse Anesthetist, Certified Registered | 4550 Investment Dr Ste 100, Troy, MI 48098-6334 | 2006-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053949289 | Douglas Ross | Physical Therapy Assistant | 4062 Livernois Rd, Troy, MI 48098 | 2020-04-01 |
| 1104382837 | Minxes Inc | Chiropractor | 1175 W. Long Lake Rd, Suite 100, Troy, MI 48098 | 2019-02-19 |
| 1689160053 | Nyssa J Swanson | Physical Therapist | 5440 Corporate Dr Ste 400, Troy, MI 48098 | 2018-07-09 |
| 1447742580 | Rebecca Jane Stros | Counselor | 900 Tower Dr, Troy, MI 48098 | 2018-06-05 |
| 1356863278 | Brigette Johnson | Occupational Therapist | 4794 Riverchase Dr, Troy, MI 48098 | 2017-07-12 |
| 1912448382 | Devyn Depeter | Technician/Technologist | 5877 Livernois Rd Ste 104, Troy, MI 48098 | 2017-03-17 |
| 1285025015 | Rochester Knee & Sports Medicine PC | Durable Medical Equipment & Medical Supplies | 4600 Investment Dr Ste 120, Troy, MI 48098 | 2015-02-16 |
| 1649690231 | Tammy Beesley-schick | Registered Nurse | 4568 Odette Ct, Troy, MI 48098 | 2014-04-22 |
| 1306269584 | Medi-care | Ambulance | 5741 Faircastle, Troy, MI 48098 | 2014-01-24 |
| 1881953644 | Diane Marie Bald | Social Worker | 1707 White Birch Ct, Troy, MI 48098 | 2012-05-14 |
| Find all providers in zip 48098 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881052363 | Surgical Assist, Plc | Physician Assistant | 4409 Gaylord Dr, Troy, MI 48098-4458 | 2016-01-29 |
| 1467952812 | Taylor Ilayne Nelson | Physician Assistant | 275 Guthrie Dr, Troy, PA 16947-8115 | 2018-02-12 |
| 1386091916 | Jeffrey Roegner | Physician Assistant | 44201 Dequindre Rd, Troy, MI 48085-1117 | 2016-05-24 |
| 1932533460 | Robert Belke | Physician Assistant | 1350 Kirts Blvd, Suite 160, Troy, MI 48084-4851 | 2013-09-03 |
| 1972884740 | Thomas James Klick Jr. | Physician Assistant | 44201 Dequindre Rd, Troy, MI 48085-1117 | 2011-09-07 |
| 1053445973 | Taibi Chbihi | Physician Assistant | 44199 Dequindre, Suite 400, Troy, MI 48085 | 2007-03-15 |
| 1417989385 | Pamela Ann Stennett | Physician Assistant | 44199 Dequindre Rd, Suite 250, Troy, MI 48085-1128 | 2006-07-07 |
| 1528015799 | Melissa Marie Mozdzen | Physician Assistant | 44201 Dequindre Rd, Troy, MI 48085-1117 | 2006-05-31 |
| 1295737815 | Melinda Sue Duff | Physician Assistant | 3130 N County Road 25a, Suite 214, Troy, OH 45373-1337 | 2005-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841835303 | Gerard M Lefebvre Jr. | Physician Assistant | 5301 Mcauley Dr Ste 5112, Ypsilanti, MI 48197-1051 | 2019-11-08 |
| 1548611023 | Michael Scott Schaeffer II | Physician Assistant | 58070 Montego Dr, New Hudson, MI 48165-9735 | 2016-06-27 |
| 1700248176 | Katilyn Kohl | Physician Assistant | 3990 John R St Ste 4905, Detroit, MI 48201-2018 | 2016-03-24 |
| 1710342134 | Evan Reid Vandenbosch | Physician Assistant | 36622 5 Mile Rd, Suite 101, Livonia, MI 48154-1900 | 2015-12-30 |
| 1619368008 | Matthew Eisen | Physician Assistant | 1560 E Sherman Blvd Ste 9, Muskegon, MI 49444-1867 | 2015-02-06 |
| 1609214972 | Jennifer Lynn Krishnan | Physician Assistant | 3601 E 13 Mile Rd, Royal Oak, MI 48073-6769 | 2013-06-10 |
| 1093028441 | Lonna Petronella Van Ast | Physician Assistant | 1022 Ada Place Dr Se, Grand Rapids, MI 49546-3786 | 2010-07-14 |
| 1669707170 | Luke Thomas Dillon | Physician Assistant | 3100 Cross Creek Pkwy Ste 200, Auburn Hills, MI 48326-2776 | 2009-10-16 |
| 1912139544 | Richard Lawrence Burgett Sr. | Physician Assistant | 4327 Stone Ridge Dr, Traverse City, MI 49684-7958 | 2009-08-15 |
| 1881822187 | Shea Mace | Physician Assistant | 6799 West Grand Blvd, Detroit, MI 48202 | 2009-06-24 |
| 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.