MEDICARE: DR. GEORGE ANTON REMISOVSKY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	C52138	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730122458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE ANTON REMISOVSKY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3386
Second Line	:	1174 YELLOWSTONE DRIVE
City	:	LAKE ARROWHEAD
State	:	CA
Zip	:	92352-3386
Country	:	US
Telephone Number	:	909-336-3778
Fax Number	:	909-336-0507

Provider Business Practice Location Address
First Line	:	29101 HOSPITAL RD.
Second Line	:	SUITE 114
City	:	LAKE ARROWHEAD
State	:	CA
Zip	:	92352-1570
Country	:	US
Telephone Number	:	909-336-3778
Fax Number	:	909-336-0507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	05/14/2009

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