Organization
GEORGE MOHAMEDALLY DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE STALIN MOHAMEDALLY DO (PHYSICIAN)
(810) 631-6373
Entity
Organization
Contact information
Practice address
387 NORTH STATE, OTISVILLE, MI 48463
(810) 631-4060
(810) 631-4101
Mailing address
PO BOX 126, OTISVILLE, MI 48463
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101007095
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1304422
—
MI
Enumeration date
04/03/2006
Last updated
08/13/2014
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