Provider Demographics
NPI:1407854870
Name:ENGELER, GEORGE PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PHILLIP
Last Name:ENGELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 QUARRY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-8635
Mailing Address - Country:US
Mailing Address - Phone:419-626-9090
Mailing Address - Fax:
Practice Address - Street 1:417 QUARRY LAKES DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-8635
Practice Address - Country:US
Practice Address - Phone:419-626-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068060E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHEN0788452OtherMEDICARE PROVIDER #
OH0247503Medicaid
OH0247503Medicaid