Healthcare Provider Details

I. General information

NPI: 1225010796
Provider Name (Legal Business Name): GEORGE C POPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 E 8 MILE RD
WARREN MI
48091-2402
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 586-840-1333
  • Fax:
Mailing address:
  • Phone: 586-840-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301065681
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301065681
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: