Provider Demographics
NPI:1598030173
Name:AMG MEDICAL,PLLC
Entity Type:Organization
Organization Name:AMG MEDICAL,PLLC
Other - Org Name:AYAD M. GEORGE M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-327-5220
Mailing Address - Street 1:740 N WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2268
Mailing Address - Country:US
Mailing Address - Phone:517-327-5220
Mailing Address - Fax:517-327-9597
Practice Address - Street 1:740 N WAVERLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2268
Practice Address - Country:US
Practice Address - Phone:517-327-5220
Practice Address - Fax:517-327-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056583291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory