MEDICARE: MANJU GEORGE

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	363LP2300X	Primary Care Nurse Practitioner	4704253592	MI

General Provider Information

NPI Number	:	1801284955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANJU GEORGE

Provider Business Mailing Address
First Line	:	29250 SUNRIDGE
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4012
Country	:	US
Telephone Number	:	586-291-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	29250 SUNRIDGE
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4012
Country	:	US
Telephone Number	:	586-291-8660
Fax Number	:

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

Provider Enumeration Date	:	12/23/2014
Last Update Date	:	12/23/2014

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Directions to “ MANJU GEORGE ” Practice Location

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