Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301111025 | MI |
Y | 208600000X | Surgeon | 4301111025 | MI |
N | 208200000X | Surgeon | L-236148 | MA |
N | 208600000X | Surgeon | L-236148 | MA |
N | 2086S0102X | Surgical Critical Care | 4301111025 | MI |
NPI | 1093974610 |
---|---|
Provider Name | Brian C George |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 07/02/2020 |