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NPI Code Detail

MEDICARE: MR. GITHU POKKAMTHANAM GEORGE

MEDICARE:  MR. GITHU POKKAMTHANAM GEORGE
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
1225200000XPhysical Therapy Assistant5502002824MI

General Provider Information

NPI Number : 1265192785
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GITHU POKKAMTHANAM GEORGE
Provider Business Mailing Address
First Line : 41039 SCARBOROUGH LN
Second Line :
City : NOVI
State : MI
Zip : 48375-2889
Country : US
Telephone Number : 678-522-1084
Fax Number :
Provider Business Practice Location Address
First Line : 9500 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48204-2132
Country : US
Telephone Number : 678-522-1084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2021
Last Update Date : 12/23/2021

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Directions to “ MR. GITHU POKKAMTHANAM GEORGE ” Practice Location

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