GREAT LAKES MEDICAL IMAGING LLC NPI 1861763005

NPI Information

  • NPI: 1861763005
  • Provider Name: GREAT LAKES MEDICAL IMAGING LLC
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Organization
  • Address: 111 N MAPLEMERE RD STE 120
    WILLIAMSVILLE, NY
    ZIP 14221
  • Phone: (716) 836-4646

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NPI Details

GREAT LAKES MEDICAL IMAGING LLC is a diagnostic radiology radiology in Williamsville, NY. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. GREAT LAKES MEDICAL IMAGING LLC NPI is 1861763005. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

111 N MAPLEMERE RD STE 120
WILLIAMSVILLE, NY
ZIP 14221-178
Phone: (716) 836-4646
Fax: (716) 836-4696

The provider's authorized official is Kenneth D Pearsen .
The authorized official title is Md and has the following contact phone number (716) 836-4646.

The enumeration date for this NPI number is 1/19/2012 and was last updated on 8/21/2023.

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
12085R0202XRadiologyDiagnostic RadiologyYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
103428622MEDICAIDNEW YORK

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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