George Dominic Mammo, MD, MS

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301501687 Issued in MI

Practice address

4420 E Davison St
Detroit, MI 48212-1744

Phone

(313) 369-1500

NPI assigned

May 16, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science

State licenses

Interoperability endpoints

• Direct secure messaging: gmammo@direct-address.org

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

{
    "created_epoch": "1494892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1659808053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3790",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480373790",
            "telephone_number": "483-364-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 E DAVISON ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482121744",
            "telephone_number": "313-369-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 E 9 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Ferndale",
            "state": "MI",
            "postal_code": "482201934",
            "country_code": "US",
            "telephone_number": "248-336-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1044 N Francisco Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606222743",
            "country_code": "US",
            "telephone_number": "773-360-6346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAMMO",
        "first_name": "GEORGE",
        "middle_name": "DOMINIC",
        "name_prefix": "Dr.",
        "credential": "MD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-16",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301501687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI STATE LIC",
            "identifier": "4301501687",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hirva Mansurali Mamdani, M.D.
• Anusha Gupta Mamidipaka, MD
• Aishat Ozohu Mamman, MD
• Isabella Mammel
• Dalia Mammo, MD
• Nicole Mammo
• Monina Serraon Mana
• Monique Mana
• Amorn Manadee, M.D.
• Maria A Manautou, DDS

• Family Medicine Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.