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General NPI Number Information
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NPI Number | 1285696682
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Entity Type | Organization
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Legal Business Name | GEORGE MOHAMEDALLY DO PC
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 387 NORTH STATE
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City | OTISVILLE
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State | MI
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Zip | 48463
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Country | US
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Telephone | 810-631-4060
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Fax | 810-631-4101
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Provider Business Mailing Address
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Address Line | PO BOX 126
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City | OTISVILLE
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State | MI
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Zip | 48463
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. GEORGE STALIN MOHAMEDALLY
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Credential | DO
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Telephone | 810-631-6373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101007095
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License Number State | MI
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