Provider Demographics
NPI:1295960524
Name:MAKDISI, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MAKDISI
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 1:555 E RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5843
Mailing Address - Country:US
Mailing Address - Phone:520-838-3540
Mailing Address - Fax:520-325-3526
Practice Address - Street 1:2404 E RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6521
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50938208G00000X
FLME125990208G00000X
AZ66589208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50938OtherKENTUCKY LICENSE
MNENROLLEDMedicaid
FL020425000Medicaid
AZ158869Medicaid
FLQ50BTOtherBLUE CROSS AND BLUE SHIELD
FLQ50BTOtherBLUE CROSS BLUE SHIELD