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General NPI Number Information
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NPI Number | 1568673531
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Entity Type | Individual
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Provider Name | GEORGE HARRY SHANLIKIAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 280 N OLD WOODWARD AVE STE 210
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City | BIRMINGHAM
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State | MI
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Zip | 48009-5324
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Country | US
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Telephone | 734-812-8412
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Fax |
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Provider Business Mailing Address
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Address Line | 280 N OLD WOODWARD AVE STE LL12
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City | BIRMINGHAM
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State | MI
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Zip | 48009-5303
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Country | US
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Telephone | 734-812-8412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C-142908
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301086792
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License Number State | MI
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