Provider Demographics
NPI:1528173812
Name:GEORGE J CARLEY DO PC
Entity type:Organization
Organization Name:GEORGE J CARLEY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:810-985-5700
Mailing Address - Street 1:1943 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1519
Mailing Address - Country:US
Mailing Address - Phone:810-985-5700
Mailing Address - Fax:810-985-5454
Practice Address - Street 1:1943 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1519
Practice Address - Country:US
Practice Address - Phone:810-985-5700
Practice Address - Fax:810-985-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS074708207Q00000X
MIJB070145207Q00000X
MIGC011673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4463388Medicaid
MIDE0592OtherMEDICARE TRAVELLERS RR
MI0N96000Medicare ID - Type Unspecified
MIF66245Medicare UPIN
MIH24114Medicare UPIN
MI4463388Medicaid