| Great Lakes Medical Center Pllc | |
|
2110 16th Street Ste. 4 Bay City MI 48708 | |
| (989) 891-9000 | |
| (989) 891-9876 |
| Full Name | Great Lakes Medical Center Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2110 16th Street, Bay City, Michigan |
| Authorized Official Name and Position | Tazeen Ahmed (OWNER) |
| Authorized Official Contact | 9898919000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Medical Center Pllc Po Box 725 Standish MI 48658-0725 Ph: (989) 891-9000 | Great Lakes Medical Center Pllc 2110 16th Street Ste. 4 Bay City MI 48708 Ph: (989) 891-9000 |
| NPI Number | 1588986996 |
|---|---|
| Provider Enumeration Date | 02/26/2010 |
| Last Update Date | 03/30/2021 |
| Medicare PECOS PAC ID | 6305974627 |
|---|---|
| Medicare Enrollment ID | O20100506001002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588986996 | NPI | - | NPPES |
| 1588986996 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | TA066513 (Michigan) | Primary |
| Provider Name | Tazeen Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356370944 PECOS PAC ID: 1254344666 Enrollment ID: I20060731000448 |
| Provider Name | Kerry Ann Thelen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457691925 PECOS PAC ID: 2860631165 Enrollment ID: I20130618000295 |
| Provider Name | Laura Krenz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093330938 PECOS PAC ID: 8729401211 Enrollment ID: I20200630002268 |
| Provider Name | Shelbi S Ramon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114593514 PECOS PAC ID: 8921408782 Enrollment ID: I20210615003517 |
| Provider Name | Tori L Vanassche |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235863861 PECOS PAC ID: 6002298304 Enrollment ID: I20220803001851 |
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