Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 057668 | MI |
NPI | 1003976408 |
---|---|
Provider Name | Christian E. George |
First Address | Grosse Pointe Park, MI 48230 |
Second Address | Grosse Pointe Park, MI 48230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CG057668 | CHAMPUS-CHAMPUS (01) | |
CG057668 | COMMERCIAL-COMMERCIAL NUMBER (01) | |
G19042 | (02) |