GREAT LAKES SPORTS MEDICINE AND CONCUSSION CLINIC (NPI# 1720441728) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720441728 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES SPORTS MEDICINE AND CONCUSSION CLINIC |
| Practice Address |
3906 Stonegate Park Ste A Saint Joseph MI 49085-9145 |
| Practice Telephone | 2694081644 |
| Practice Fax Number | 2694280019 |
| Mailing Telephone | 2694081644 |
| Mailing Fax Number | 2694280019 |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-03-29 |
| Authorized Official Name | MR. CHRISTOPHER TRIGGER (OWNER) |
| Authorized Official Telephone | 2694081644 |
| Authorized Official Credential | M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| Street Address |
3906 STONEGATE PARK STE A |
| City | SAINT JOSEPH |
| State | MI |
| Zip Code | 49085-9145 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134758949 | Ahmed Elshareif | Student in an Organized Health Care Education/Training Program | Lakeland Health, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2020-04-03 |
| 1033747225 | Ezra Fox | Student in an Organized Health Care Education/Training Program | Lakeland Health- Gme, 1234 Napier Avenue, St. Joseph, MI 49085 | 2020-04-01 |
| 1679033930 | Asad Butt | Student in an Organized Health Care Education/Training Program | Lakeland Health-gme, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2019-03-22 |
| 1184194714 | Benjamin Phillip Knuth | Physical Therapist | 3950 Hollywood Road, Suite 140, Saint Joseph, MI 49085 | 2018-11-27 |
| 1336624279 | Brandi Chatot | Counselor | 1101 Broad Street #8, Saint Joseph, MI 49085 | 2018-09-26 |
| 1396239562 | Lakeland Medical Practices | Family Medicine | 2500 Niles Ave., Suite 1, St. Joseph, MI 49085 | 2018-06-20 |
| 1760976518 | Premier Health Associates, Inc. | Home Health | 1111 Main Sr, St Joseph, MI 49085 | 2018-06-15 |
| 1053817783 | Chantell Strong | Student in an Organized Health Care Education/Training Program | Lakeland Health - Gme, 1234 Napier Avenue, Saint Joseph, MI 49085 | 2018-04-02 |
| 1386144053 | Anjana Gupta, Dds, Pllc | Dentist | 2800 Niles Road, Saint Joseph, MI 49085 | 2018-02-19 |
| 1356858997 | Hope Reborn Counseling, Pllc | Counselor | 2816 Willa Dr, Saint Joseph, MI 49085 | 2018-01-04 |
| Find all providers in zip 49085 | ||||
| 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 |
|---|---|---|---|---|
| 1366714131 | Gary Steven Nadolski | Specialist | 44 Court Dr, Saint Joseph, MO 64506-4315 | 2012-02-08 |
| 1700041522 | Bernard E Libel | Specialist | 1105 S Belt Hwy, Saint Joseph, MO 64507-2224 | 2008-07-21 |
| 1598784050 | David Andrew Driscoll | Specialist | 2516 Niles Ave, Saint Joseph, MI 49085-1937 | 2006-07-18 |
| 1275584419 | St Joseph Neurology | Specialist | 105 Far West Dr, Ste 203, Saint Joseph, MO 64506-3500 | 2006-05-12 |
| 1700858180 | St. Joseph Family Medical Clinic, Inc. | Specialist | 2120 S Riverside Rd, Saint Joseph, MO 64507-2535 | 2006-02-01 |
| 1679570444 | Joel Phillip Karasek | Specialist | 3955 Sherman Ave, Saint Joseph, MO 64506-3649 | 2005-07-07 |
| 1013914241 | Samuel Ernest Logan | Specialist | 3901 Stonegate Park, Suite 300, Saint Joseph, MI 49085-9137 | 2005-07-01 |
| 1063416642 | Sutinderpal S. Judge | Specialist | 2550 Niles Rd, Saint Joseph, MI 49085 | 2005-06-10 |
| 1619155611 | Barrett and Driscoll,md's,pc | Specialist | 2516 Niles Ave, Saint Joseph, MI 49085-1937 | 2008-02-01 |
| 1821201500 | Lake Michigan Nephrology, L.l.c | Specialist | 3800 Hollywood Rd, Suite 104, Saint Joseph, MI 49085-8510 | 2007-05-08 |
| Find all providers in SAINT JOSEPH | ||||
| City | SAINT JOSEPH |
| Zip Code | 49085 |
Please comment or provide details below to improve the information on GREAT LAKES SPORTS MEDICINE AND CONCUSSION CLINIC.
| 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.