Provider Demographics
NPI:1417156894
Name:GREAT LAKES DURABLE MEDICAL EQUIPMENT SUPPLIES
Entity Type:Organization
Organization Name:GREAT LAKES DURABLE MEDICAL EQUIPMENT SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YASIR
Authorized Official - Middle Name:MIRZA
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-239-5318
Mailing Address - Street 1:3085 HALLMARK CT STE 2
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-6803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3085 HALLMARK CT STE 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-6803
Practice Address - Country:US
Practice Address - Phone:989-790-3769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies