Provider Demographics
NPI:1063824860
Name:HUGHES, GEORGE
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:HUGHES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 SUNBURST DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1146
Mailing Address - Country:US
Mailing Address - Phone:269-501-2606
Mailing Address - Fax:269-585-5971
Practice Address - Street 1:6630 SUNBURST DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-501-2606
Practice Address - Fax:269-585-5971
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050924208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301050924OtherLICENSE