Individual
DR. GEORGE DOMINIC MAMMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MS
Contact information
Practice address
4420 E DAVISON ST, DETROIT, MI 48212-1744
(313) 369-1500
Mailing address
PO BOX 3790, SOUTHFIELD, MI 48037-3790
(483) 364-0002
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301501687
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301501687
MI STATE LIC
MI
Enumeration date
05/16/2017
Last updated
09/23/2020
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