Organization · Type 2 NPI
Great Lakes Dialysis, L.l.c.
End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Detroit, MI
NPI number
1720095417
Active
Practice location
14614 Kercheval St
Detroit, MI 48215-2814
Fax (313) 332-0334
Mailing address
PO Box 428
Lockport, IL 60441-6428
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary | 261QE0700X | 4301072901 (MI) |
End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...
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About NPI 1720095417
Great Lakes Dialysis, L.l.c.'s National Provider Identifier is 1720095417, issued on Aug 2, 2006. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Detroit, MI. The record was last updated on Apr 7, 2025.