MEDICARE: DR. GEORGE J MURAKAWA MD PHD

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	207NS0135X	Procedural Dermatology Physician	GM077180	MI
2	207N00000X	Dermatology Physician	4301077180	MI
3	207ND0101X	MOHS-Micrographic Surgery Physician	GM077180	MI
4	207ND0900X	Dermatopathology Physician	GM077180	MI
5	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	GM077180	MI
6	207NP0225X	Pediatric Dermatology Physician	GM077180	MI

General Provider Information

NPI Number	:	1265422497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE J MURAKAWA MD PHD

Provider Business Mailing Address
First Line	:	255 KIRTS BLVD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-5260
Country	:	US
Telephone Number	:	248-244-8448
Fax Number	:	248-244-8766

Provider Business Practice Location Address
First Line	:	255 KIRTS BLVD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-5260
Country	:	US
Telephone Number	:	248-244-8448
Fax Number	:	248-244-8766

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	03/31/2021

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