Provider Demographics
NPI:1982960316
Name:GREAT LAKES PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:GREAT LAKES PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-581-1623
Mailing Address - Street 1:22214 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2420
Mailing Address - Country:US
Mailing Address - Phone:313-581-1623
Mailing Address - Fax:313-581-4683
Practice Address - Street 1:22214 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2420
Practice Address - Country:US
Practice Address - Phone:313-581-1623
Practice Address - Fax:313-581-4683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy