Great Lakes Foot and Ankle an Anatomic Pathology Laboratory – Anatomic Pathology & Clinical Pathology Physician, NPI 1417620170
Anatomic Pathology & Clinical Pathology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Great Lakes Foot and Ankle an Anatomic Pathology Laboratory
32743 23 MILE RD STE 210
CHESTERFIELD, MI 480472176
Phone: (586) 725-3444
Fax: (586) 725-0984
Type: Mailing
32743 23 MILE RD STE 110
CHESTERFIELD, MI 480472082
Phone: (586) 725-3444
Fax: (586) 725-0984
Type: Location
9400 S CICERO AVE STE 100
OAK LAWN, IL 604532536
Phone: (708) 424-3201
Fax: (708) 424-5001
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-08-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-08-31 (82 days away).
Enrollment records
1
Earliest due date
2026-08-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20210811002518 | O | Independent Clinical Laboratory | MI | 2026-08-31 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48047)
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