Provider Demographics
NPI:1831695543
Name:GREAT LAKES RESEARCH GROUP, INC.
Entity type:Organization
Organization Name:GREAT LAKES RESEARCH GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:VITTITOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-895-9100
Mailing Address - Street 1:200 S WENONA ST STE 170
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8831
Mailing Address - Country:US
Mailing Address - Phone:989-895-9100
Mailing Address - Fax:989-895-9200
Practice Address - Street 1:200 S WENONA ST STE 170
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8831
Practice Address - Country:US
Practice Address - Phone:989-895-9100
Practice Address - Fax:989-895-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch