1457925208 NPI number — MR. GEORGE FELEMEGOS M.D

Table of content: MR. GEORGE FELEMEGOS M.D (NPI 1457925208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457925208 NPI number — MR. GEORGE FELEMEGOS M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELEMEGOS
Provider First Name:
GEORGE
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457925208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16001 WEST 9 MILE ROAD, 4 FISCHER ROOM 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
247-849-3151
Provider Business Mailing Address Fax Number:
248-849-3222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 N JAMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13440-2844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-338-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4351049442 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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