Healthcare Provider Details

I. General information

NPI: 1033037700
Provider Name (Legal Business Name): MARINA MEDHAT GEORGE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEADOWBROOK RD STE 208
NOVI MI
48375-1882
US

IV. Provider business mailing address

20108 BALDWIN CIR
HOLLY MI
48442-9395
US

V. Phone/Fax

Practice location:
  • Phone: 248-200-9240
  • Fax:
Mailing address:
  • Phone: 732-979-0489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601014132TMP26
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: