Provider Demographics
NPI:1285800094
Name:JOSEPH A. GEORGE,MD,PC
Entity type:Organization
Organization Name:JOSEPH A. GEORGE,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:AMIR
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-386-3200
Mailing Address - Street 1:4006 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-4111
Mailing Address - Country:US
Mailing Address - Phone:313-386-3200
Mailing Address - Fax:313-388-3335
Practice Address - Street 1:4006 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-4111
Practice Address - Country:US
Practice Address - Phone:313-386-3200
Practice Address - Fax:313-388-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048291261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102959033Medicaid
MI0823642Medicare PIN
MI102959033Medicaid