Provider Demographics
NPI:1467800466
Name:GEORGE, PRINCY ANN (MD)
Entity Type:Individual
Prefix:
First Name:PRINCY
Middle Name:ANN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRINCY
Other - Middle Name:ANN
Other - Last Name:KOSHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:455 W COURT ST STE 400
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3695
Mailing Address - Country:US
Mailing Address - Phone:815-937-8744
Mailing Address - Fax:
Practice Address - Street 1:455 W COURT ST STE 400
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3695
Practice Address - Country:US
Practice Address - Phone:815-937-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036162093207Q00000X
PAMD467838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine