Provider Demographics
NPI:1780175687
Name:KARDOUSS, GEORGE (DPM)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KARDOUSS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 MASON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2841
Mailing Address - Country:US
Mailing Address - Phone:248-250-4738
Mailing Address - Fax:
Practice Address - Street 1:1213 MASON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2841
Practice Address - Country:US
Practice Address - Phone:313-561-2446
Practice Address - Fax:313-561-7299
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002723213ES0103X
MI5901400415213ES0103X
MI5951000847213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery