Provider Demographics
NPI:1144111840
Name:GREAT LAKES UROGYNECOLOGY PLC
Entity type:Organization
Organization Name:GREAT LAKES UROGYNECOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JACYLN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARATONO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-835-2797
Mailing Address - Street 1:33681 CROOKS ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173-9322
Mailing Address - Country:US
Mailing Address - Phone:248-835-2797
Mailing Address - Fax:
Practice Address - Street 1:19249 ALLEN RD STE B
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1189
Practice Address - Country:US
Practice Address - Phone:248-835-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Multi-Specialty