GREAT LAKES INTEGRATIVE WELLNESS NPI 1679262893

NPI Information

  • NPI: 1679262893
  • Provider Name: GREAT LAKES INTEGRATIVE WELLNESS
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Address: 2177 FOREST PARK RD
    NORTON SHORES, MI
    ZIP 49441
  • Phone: (269) 286-2025

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NPI Details

GREAT LAKES INTEGRATIVE WELLNESS is a primary care clinic center in Norton Shores, MI. GREAT LAKES INTEGRATIVE WELLNESS NPI is 1679262893. The provider is registered as an organization entity type.

The provider's business location address is:

2177 FOREST PARK RD
NORTON SHORES, MI
ZIP 49441-517
Phone: (269) 286-2025

The provider's authorized official is Darci Samuel .
The authorized official title is Founder and has the following contact phone number (269) 286-2025.

The enumeration date for this NPI number is 5/3/2023 and was last updated on 5/3/2023.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareYes

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: 11/21/2025

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