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General NPI Number Information
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NPI Number | 1861928681
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Entity Type | Individual
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Provider Name | GEORGE BRIAN GENNAOUI D.O
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 4700 SCHAEFER RD STE 270
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City | DEARBORN
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State | MI
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Zip | 48126-3743
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Country | US
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Telephone | 947-523-4670
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Fax | 313-943-2915
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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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 |
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 5101027962
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 34.015633
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 79972
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License Number State | MN
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