| Great Lakes Physicians Pc | |
|
36180 Five Mile Road Livonia MI 48154 | |
| (734) 591-7666 | |
| (734) 591-2426 |
| Full Name | Great Lakes Physicians Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 36180 Five Mile Road, Livonia, Michigan |
| Authorized Official Name and Position | Jayshree Desai (OWNER) |
| Authorized Official Contact | 7345917666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Physicians Pc 36180 Five Mile Road Livonia MI 48154 Ph: (734) 591-7666 | Great Lakes Physicians Pc 36180 Five Mile Road Livonia MI 48154 Ph: (734) 591-7666 |
| NPI Number | 1164591053 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 09/28/2012 |
| Medicare PECOS PAC ID | 1355341223 |
|---|---|
| Medicare Enrollment ID | O20061228000359 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164591053 | NPI | - | NPPES |
| 3323140 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jayshree M Desai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396752283 PECOS PAC ID: 9931105426 Enrollment ID: I20061005000391 |
| Provider Name | Surendra Kelwala |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558475517 PECOS PAC ID: 1052318748 Enrollment ID: I20061020000452 |
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