Provider Demographics
NPI:1669702981
Name:PRAMSTALLER, GEORGE JOHN (DO)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JOHN
Last Name:PRAMSTALLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OSBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAULT STE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1822
Mailing Address - Country:US
Mailing Address - Phone:906-635-4460
Mailing Address - Fax:906-635-7872
Practice Address - Street 1:509 OSBORN BLVD
Practice Address - Street 2:
Practice Address - City:SAULT STE. MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783
Practice Address - Country:US
Practice Address - Phone:906-635-4460
Practice Address - Fax:906-635-7872
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006369208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice