Provider Demographics
NPI:1023799384
Name:GREAT LAKES DURABLE MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:GREAT LAKES DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-431-9281
Mailing Address - Street 1:9285 COUNTRY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6651
Mailing Address - Country:US
Mailing Address - Phone:734-489-3094
Mailing Address - Fax:
Practice Address - Street 1:12701 TELEGRAPH RD STE 205
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6851
Practice Address - Country:US
Practice Address - Phone:734-643-5028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies