Provider Demographics
NPI:1114029840
Name:GEORGAKOPOULOS, JOHN S (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:GEORGAKOPOULOS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-0100
Mailing Address - Fax:989-583-0108
Practice Address - Street 1:5570 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3583
Practice Address - Country:US
Practice Address - Phone:989-583-0100
Practice Address - Fax:989-583-0108
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010863207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4396122Medicaid
MI4396122Medicaid
MIM23560097Medicare PIN