Provider Demographics
NPI:1326318338
Name:GEORGE C HAWROT PLLC
Entity Type:Organization
Organization Name:GEORGE C HAWROT PLLC
Other - Org Name:GEORGE C. HAWROT M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MELVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-624-8400
Mailing Address - Street 1:3815 PELHAM RD.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4146
Mailing Address - Country:US
Mailing Address - Phone:313-624-8400
Mailing Address - Fax:313-624-8404
Practice Address - Street 1:3815 PELHAM RD.
Practice Address - Street 2:SUITE 5
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4146
Practice Address - Country:US
Practice Address - Phone:313-624-8400
Practice Address - Fax:313-624-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGH048271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4788427Medicaid
MIP00293891OtherRAILROAD MEDICARE
MI1109515041OtherBCBS
MIB46025Medicare UPIN
MI1109515041OtherBCBS