Provider Demographics
NPI:1568673531
Name:SHANLIKIAN, GEORGE HARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HARRY
Last Name:SHANLIKIAN
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 1:280 N OLD WOODWARD AVE STE LL12
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5303
Mailing Address - Country:US
Mailing Address - Phone:734-812-8412
Mailing Address - Fax:
Practice Address - Street 1:280 N OLD WOODWARD AVE STE 210
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5324
Practice Address - Country:US
Practice Address - Phone:734-812-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-142908207R00000X
MI4301086792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine