Provider Type Icon

GREAT LAKES PEDIATRIC ASSOCIATES NPI 1023342474


NPI Information

NPI: 1023342474
Provider Name: GREAT LAKES PEDIATRIC ASSOCIATES
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 23D1040817

Address:
3400 PINETREE RD
STE 102
LANSING, MI
ZIP 48911
Phone: (517) 887-3000
Get Directions

GREAT LAKES PEDIATRIC ASSOCIATES is a pediatrics in Lansing, MI. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. GREAT LAKES PEDIATRIC ASSOCIATES NPI is 1023342474. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

3400 PINETREE RD
STE 102
LANSING, MI
ZIP 48911-286
Phone: (517) 887-3000

The provider's authorized official is Beth Ileen Charles .
The authorized official title is Practice Manager and has the following contact phone number (517) 887-3000.

The CLIA number assigned to this NPI record is 23D1040817 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/1/2009 and was last updated on 10/1/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics4301063626MICHIGANNo
2208000000XPediatrics4301078945MICHIGANNo
3208000000XPediatrics4301086445MICHIGANNo
4208000000XPediatrics4301049233MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13080275MEDICAIDMICHIGAN
21831309921OTHERMICHIGANNPI
31144338443OTHERMICHIGANNPI
41144338450OTHERMICHIGANNPI
51730297045OTHERMICHIGANNPI
63069367MEDICAIDMICHIGAN
74366885MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.