Provider Demographics
NPI:1871761247
Name:POLETES, GEORGE PETER (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PETER
Last Name:POLETES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1219 E SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5523
Mailing Address - Country:US
Mailing Address - Phone:517-485-3583
Mailing Address - Fax:517-485-3942
Practice Address - Street 1:1219 E SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5523
Practice Address - Country:US
Practice Address - Phone:517-485-3583
Practice Address - Fax:517-485-3942
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301069777208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF47266Medicare UPIN