Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 4301033816 | MI |
NPI | 1154408433 |
---|---|
Provider Name | Rachel George |
First Address | Westland, MI 48185 |
Second Address | Westland, MI 48185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1263688 | (05) | MI |
350H27763 | BLUE CROSS (01) | MI |
B48336 | (02) |