Provider Demographics
NPI:1124018627
Name:GEORGE, ATIF M (MD)
Entity Type:Individual
Prefix:DR
First Name:ATIF
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:23760 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1130
Mailing Address - Country:US
Mailing Address - Phone:248-543-2800
Mailing Address - Fax:248-543-2814
Practice Address - Street 1:23760 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT RIDGE
Practice Address - State:MI
Practice Address - Zip Code:48069-1130
Practice Address - Country:US
Practice Address - Phone:248-543-2800
Practice Address - Fax:248-543-2814
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3431423Medicaid
MI3431423Medicaid
B47566Medicare UPIN