=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477660280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGE L. FIGACZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 02/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 HARRINGTON ST RADIOLOGY DEPT
-----------------------------------------------------
City | MOUNT CLEMENS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48043-2920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-493-8098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1159 E MICHIGAN AVE
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48198-5807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-370-8980
-----------------------------------------------------
Fax | 248-276-0274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 4301046206
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------