Healthcare Provider Details

I. General information

NPI: 1871761247
Provider Name (Legal Business Name): GEORGE PETER POLETES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 E SAGINAW ST
LANSING MI
48906-5523
US

IV. Provider business mailing address

1219 E SAGINAW ST
LANSING MI
48906-5523
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-3583
  • Fax: 517-485-3942
Mailing address:
  • Phone: 517-485-3583
  • Fax: 517-485-3942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301069777
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: