Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4301077180 | MI |
N | 207ND0101X | MOHS-Micrographic Surgeon | GM077180 | MI |
N | 207ND0900X | Dermatopathologist | GM077180 | MI |
N | 207NP0225X | Pediatric Dermatologist | GM077180 | MI |
N | 207NS0135X | Procedural Dermatology | GM077180 | MI |
NPI | 1265422497 |
---|---|
Provider Name | Dr. George J Murakawa |
First Address | Troy, MI 48084-5260 |
Second Address | Troy, MI 48084-5260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G36695 | (02) |