DR. GEORGE DOMINIC MAMMO (NPI# 1659808053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659808053 |
| Entity Type | Individual |
| Full Name | DR. GEORGE DOMINIC MAMMO |
| Credential | MD, MS |
| Practice Address |
4420 E Davison St Detroit MI 48212-1744 |
| Mailing Address |
Po Box 3790 Southfield MI 48037-3790 |
| Practice Telephone | 3133691500 |
| Mailing Telephone | 4833640002 |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2020-09-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 4301501687 | MI | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MI STATE LIC | 4301501687 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1044 N Francisco Ave, Chicago, IL 606222743 | 7733606346 | |
| 911 E 9 Mile Rd, Ferndale, MI 482201934 | 2483364000 |
| Street Address |
4420 E DAVISON ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48212-1744 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730172529 | Knight Prescriptions, Ltd | Pharmacy | 4420 E Davison St, Detroit, MI 48212-1744 | 2005-08-26 |
| 1366954067 | E Davidson Rx LLC | Pharmacy | 4420 E Davison St, Detroit, MI 48212-1744 | 2017-11-02 |
| 1982881025 | Great Lakes Family Medical Center Pllc | Clinic/Center | 4420 E Davison St, Detroit, MI 48212-1744 | 2008-01-30 |
| 1598737769 | Great Lakes Family Medical Center Pllc | Family Medicine | 4420 E Davison St, Detroit, MI 48212-1744 | 2006-02-02 |
| 1770554164 | Arunima Shrivastava | Family Medicine | 4420 E Davison St, Detroit, MI 48212-1744 | 2006-02-01 |
| 1316918899 | Amitabh Paharia | Family Medicine | 4420 E Davison St, Detroit, MI 48212-1744 | 2006-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720689193 | Mohammed Louthfur Rahman | Nurse Practitioner | Hoover Internal Medicine Pllc, 2930 Holbrook St, Hamtramck, MI 48212 | 2020-11-03 |
| 1386243178 | Hoover Internal Medicine Pllc | Internal Medicine | 4067 Georgia St, Hamtramck, MI 48212 | 2020-10-22 |
| 1013514538 | Ranim Suliman | Dentist | 9824 Conant St, Hamtramck, MI 48212 | 2020-10-07 |
| 1942770631 | Joann Harrison | Nurse Practitioner | 17941 St. Aubin Street, Detroit, MI 48212 | 2018-11-26 |
| 1134605298 | Advanced Medical Equipment Inc | Durable Medical Equipment & Medical Supplies | 9740 Conant St Ste 4, Hamtramck, MI 48212 | 2018-07-12 |
| 1477051530 | Detroit Green Carrot LLC | Foster Care Agency | 3829 Alpha, Detroit, MI 48212 | 2018-01-24 |
| 1528595451 | Mercy Prakash | Nurse Practitioner | 3120 Carpenter St. Ste 201, Adult & Pediatric Medicine Pllc, Hamtramck, MI 48212 | 2017-05-23 |
| 1033408935 | Hamtramck Pediatrics | Clinic/Center | 12033 Conant Road, Hamtramck, MI 48212 | 2011-03-31 |
| 1194051557 | Niaah Ellis | Counselor | 4812 E. Mcnichols, Detroit, MI 48212 | 2009-10-20 |
| 1912136797 | Latoya T Jackosn | Counselor | Sunshine Treatment In, 4821 E. Mcnichols, Detroit, MI 48212 | 2009-07-14 |
| Find all providers in zip 48212 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194354811 | Lorie Ann Turner | Family Medicine | 1728 Sheridan St, Detroit, MI 48214-2410 | 2020-04-04 |
| 1134787633 | Behavioral Health Professionals, Inc | Family Medicine | 19750 Burt Road, Detroit, MI 48219 | 2019-05-31 |
| 1508326687 | Randi Nguyen | Family Medicine | 22151 Moross Rd Ste 212, Detroit, MI 48236-2177 | 2019-03-23 |
| 1982194338 | Green Cross Medical Center PC | Family Medicine | 18041 Greenfield Rd, Detroit, MI 48235-3120 | 2018-05-11 |
| 1205339306 | Conant Family Care Pllc | Family Medicine | 3611 Carpenter St Ste 5, Detroit, MI 48212-2784 | 2018-03-14 |
| 1801303086 | St Mary Mercy Physician Practices | Family Medicine | 5555 Conner St Ste 2691, Detroit, MI 48213-3812 | 2018-01-09 |
| 1427408376 | Raquel Orlich | Family Medicine | 1620 Michigan Ave Ste 125, Detroit, MI 48216-1493 | 2016-06-21 |
| 1295181543 | Ammar Charestan | Family Medicine | 6071 Outer Dr W, Detroit, MI 48235 | 2016-05-05 |
| 1629423652 | Rajni Parmar | Family Medicine | 6001 W Outer Dr Ste 430, Detroit, MI 48235-2626 | 2016-04-27 |
| 1265886733 | Benjamin Abraham | Family Medicine | One Ford Place 2e, Henry Ford Hospital, Department of Family Medicine, Detroit, MI 48202 | 2016-04-20 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.