Provider Demographics
NPI:1720563281
Name:GREAT LAKES EXTREMITIES AND ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:GREAT LAKES EXTREMITIES AND ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAKLITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-869-6344
Mailing Address - Street 1:900 INDIAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8536
Mailing Address - Country:US
Mailing Address - Phone:330-869-6344
Mailing Address - Fax:330-869-6366
Practice Address - Street 1:900 INDIAN HILL DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8536
Practice Address - Country:US
Practice Address - Phone:330-869-6344
Practice Address - Fax:330-869-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies