Healthcare Provider Details

I. General information

NPI: 1124933114
Provider Name (Legal Business Name): ERICA GEORGE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 CALIFORNIA ST
HIGHLAND PARK MI
48203-3517
US

IV. Provider business mailing address

13200 NORTHFIELD BLVD
OAK PARK MI
48237-1642
US

V. Phone/Fax

Practice location:
  • Phone: 630-487-0813
  • Fax:
Mailing address:
  • Phone: 313-460-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: