NPIMap

Organization Active NPI

George Mohamedally DO PC

  • Family Medicine Physician
  • Otisville, MI
National Provider Identifier
1285696682
Registry record updated Aug 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101007095 Issued in MI
Legal business name
GEORGE MOHAMEDALLY DO PC
Practice address
387 North State
Otisville, MI 48463
Phone
(810) 631-4060
Fax
(810) 631-4101
NPI assigned
Apr 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. George Stalin Mohamedally, DO
Title
Physician
Phone
(810) 631-6373

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 5101007095 MI Primary

Addresses

Primary practice location

387 North State
Otisville, MI 48463

Mailing address

PO Box 126
Otisville, MI 48463

Other identifiers 1

IdentifierTypeStateIssuer
1304422MedicaidMI

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407888000000",
    "number": "1285696682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 126",
            "city": "OTISVILLE",
            "state": "MI",
            "postal_code": "48463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 NORTH STATE",
            "city": "OTISVILLE",
            "state": "MI",
            "postal_code": "48463",
            "telephone_number": "810-631-4060",
            "fax_number": "810-631-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE MOHAMEDALLY DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2014-08-13",
        "status": "A",
        "authorized_official_last_name": "MOHAMEDALLY",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "STALIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "810-631-6373",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101007095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1304422",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Otisville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.