Provider Demographics
NPI:1891739355
Name:PROCENTO, GEORGE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:PROCENTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:755 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3253
Mailing Address - Country:US
Mailing Address - Phone:847-918-9179
Mailing Address - Fax:847-918-9635
Practice Address - Street 1:755 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3253
Practice Address - Country:US
Practice Address - Phone:847-918-9179
Practice Address - Fax:847-918-9635
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine