Individual
DR. EDWIN BLACK GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
4201 ST ANTOINE STE 8A & 8B, UNIVERSITY HEALTH CENTER, DETROIT, MI 48201-2153
(313) 745-4275
(313) 745-4468
Mailing address
1560 E MAPLE RD, SUITE 400-CREDENTIALING, TROY, MI 48083-1138
(313) 745-4275
(313) 745-4468
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
4301068940
MI
2084N0600X
Clinical Neurophysiology Physician
4301068940
MI
Other
Enumeration date
06/01/2006
Last updated
08/03/2016
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