Provider Demographics
NPI:1427334853
Name:DR GEORGE INC
Entity type:Organization
Organization Name:DR GEORGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-381-2174
Mailing Address - Street 1:3108 S ROUTE 59
Mailing Address - Street 2:SUITE 124/160
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8021
Mailing Address - Country:US
Mailing Address - Phone:224-381-2174
Mailing Address - Fax:
Practice Address - Street 1:3108 S ROUTE 59
Practice Address - Street 2:SUITE 124/160
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8021
Practice Address - Country:US
Practice Address - Phone:224-381-2174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL061-005297213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty