Provider Demographics
NPI:1871613570
Name:GHUNEIM, JOHN GEORGE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GEORGE
Last Name:GHUNEIM
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 1:1235 INDUSTRIAL DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1741
Mailing Address - Country:US
Mailing Address - Phone:734-429-2581
Mailing Address - Fax:734-429-3410
Practice Address - Street 1:1235 INDUSTRIAL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1741
Practice Address - Country:US
Practice Address - Phone:734-429-2581
Practice Address - Fax:734-429-3410
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051614171100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE85431Medicare UPIN