Provider Demographics
NPI:1215120498
Name:GEORGE C EL HAJJ DPM PC
Entity type:Organization
Organization Name:GEORGE C EL HAJJ DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:EL NAJJ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-540-5560
Mailing Address - Street 1:31815 SOUTHFIELD ROAD
Mailing Address - Street 2:STE 28
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-540-5560
Mailing Address - Fax:
Practice Address - Street 1:31815 SOUTHFIELD ROAD
Practice Address - Street 2:STE 28
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-540-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000674213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1695576Medicaid
5635298Medicare PIN
MI1695576Medicaid