MEDICARE: DR. GEORGE ROBERT FLEMING JR. PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301003724	MI

General Provider Information

NPI Number	:	1245329473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE ROBERT FLEMING JR. PH.D.

Provider Business Mailing Address
First Line	:	243 WEST CONGRESS ST
Second Line	:	SUITE 350
City	:	DETROIT
State	:	MI
Zip	:	48226-3262
Country	:	US
Telephone Number	:	313-567-2234
Fax Number	:	313-567-2817

Provider Business Practice Location Address
First Line	:	243 WEST CONGRESS ST
Second Line	:	SUITE 350
City	:	DETROIT
State	:	MI
Zip	:	48226-3262
Country	:	US
Telephone Number	:	313-567-2234
Fax Number	:	313-567-2817

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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