OrganizationActive
Great Lakes Neuromonitoring, PLLC
NPI 1457866873 · Clinical Neurophysiology Physician · Waterford, MI
Provider details
- NPI number
- 1457866873
- Entity type
- Organization
- Primary specialty
- Clinical Neurophysiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Lizette Morin, Mdms Npi Compliance Officer(210) 598-2801
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Electrodiagnostic Medicine Physician204R00000X
Allopathic & Osteopathic Physicians
- Neurology Physician2084N0400X
Allopathic & Osteopathic Physicians
Technologists, Technicians & Other Technical Service Providers
Practice location
5119 Highland Rd
(m-59) #389
Waterford, MI 48327-1915
Phone: (248) 309-6631
Approximate (ZIP-level) locationGet directions
Mailing address
5119 Highland Rd
Waterford, MI 48327-1915
Registry dates
- Enumerated
- 2017-12-07
- Last updated
- 2017-12-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.