Provider Demographics
NPI:1457415044
Name:GERMAIN, GEORGES B (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGES
Middle Name:B
Last Name:GERMAIN
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 1:6307 S STEWART AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3116
Mailing Address - Country:US
Mailing Address - Phone:844-431-0411
Mailing Address - Fax:844-431-0411
Practice Address - Street 1:6307 S STEWART AVE STE 304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:844-431-0411
Practice Address - Fax:844-431-0411
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046138Medicaid
IL745861Medicare ID - Type Unspecified
ILC44037Medicare UPIN