Provider Demographics
NPI:1568449882
Name:KODSY, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:KODSY
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:4444 W BRISTOL RD
Practice Address - Street 2:STE #150
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3153
Practice Address - Country:US
Practice Address - Phone:810-230-9500
Practice Address - Fax:810-230-0286
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4471512Medicaid
MIH77767Medicare UPIN
MAOM40150066Medicare ID - Type Unspecified