Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301117075 | MI |
N | 208600000X | Surgeon | 4301117075 | MI |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 4301117075 | MI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | ME102425 | FL |
NPI | 1033173463 |
---|---|
Provider Name | Kristopher Mahlon George |
First Address | Southfield, MI 48075-4818 |
Second Address | Southfield, MI 48075-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 26/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000341300 | (05) | FL |
I39900 | (02) | OH |
P01281024 | RR MEDICARE (01) | FL |