Provider Demographics
NPI:1326052093
Name:PICHA, GEORGE J (MD PHD FACS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:PICHA
Suffix:
Gender:M
Credentials:MD PHD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5005 ROCKSIDE RD STE 640
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6808
Mailing Address - Country:US
Mailing Address - Phone:216-328-0800
Mailing Address - Fax:216-328-1860
Practice Address - Street 1:5005 ROCKSIDE RD STE 640
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6808
Practice Address - Country:US
Practice Address - Phone:216-328-0800
Practice Address - Fax:216-328-1860
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-1876-P208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0647018Medicaid
OH0647018Medicaid
OHPI0589392Medicare ID - Type Unspecified