Provider Demographics
NPI:1518929793
Name:GEORGE, TOBIAS VALENTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:TOBIAS
Middle Name:VALENTINE
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-569-4366
Mailing Address - Fax:248-569-4614
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-569-4366
Practice Address - Fax:248-569-4614
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITG030884207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP40826OtherBCN
MI18OF372710OtherBCBS
MI1319522Medicaid
MIP40826OtherBCN
MIOF37271002Medicare ID - Type Unspecified