Provider Demographics
NPI:1194382721
Name:GREAT LAKES NEUROTECHNOLOGIES INC
Entity Type:Organization
Organization Name:GREAT LAKES NEUROTECHNOLOGIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR QUALITY & REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:TARLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-361-5410
Mailing Address - Street 1:6100 ROCKSIDE WOODS BLVD N STE 415
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2339
Mailing Address - Country:US
Mailing Address - Phone:216-361-5410
Mailing Address - Fax:216-361-5420
Practice Address - Street 1:6100 ROCKSIDE WOODS BLVD N STE 415
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44131-2339
Practice Address - Country:US
Practice Address - Phone:216-361-5410
Practice Address - Fax:216-361-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies