Healthcare Provider Details

I. General information

NPI: 1457744617
Provider Name (Legal Business Name): AYAD M GEORGE M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N WAVERLY RD
LANSING MI
48917-2268
US

IV. Provider business mailing address

740 N WAVERLY RD
LANSING MI
48917-2268
US

V. Phone/Fax

Practice location:
  • Phone: 517-327-5220
  • Fax: 517-327-9597
Mailing address:
  • Phone: 517-327-5220
  • Fax: 517-327-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4301056583
License Number StateMI

VIII. Authorized Official

Name: DR. AYAD MICHAEL GEORGE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 517-327-5220