Provider Demographics
NPI:1134291255
Name:GEORGE, A SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:SUSAN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 BLOOMCREST DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2518
Mailing Address - Country:US
Mailing Address - Phone:248-227-1377
Mailing Address - Fax:
Practice Address - Street 1:3475 BLOOMCREST DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2518
Practice Address - Country:US
Practice Address - Phone:248-227-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010632812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI26-0-63-44-31OtherBCBS
MIN36890004Medicare PIN