Provider Demographics
NPI:1720300510
Name:GEORGE NASSIF, M.D PLLC
Entity Type:Organization
Organization Name:GEORGE NASSIF, M.D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:NASSIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-263-3312
Mailing Address - Street 1:39621 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4302
Mailing Address - Country:US
Mailing Address - Phone:586-263-3312
Mailing Address - Fax:586-226-4441
Practice Address - Street 1:39621 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4302
Practice Address - Country:US
Practice Address - Phone:586-263-3312
Practice Address - Fax:586-226-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085498207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0500784OtherBCBSM