Provider Demographics
NPI:1366887788
Name:GENEMEDICS HEALTH INSTITUTE P.C.
Entity type:Organization
Organization Name:GENEMEDICS HEALTH INSTITUTE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:SHANLIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-812-8412
Mailing Address - Street 1:280 N OLD WOODWARD AVE
Mailing Address - Street 2:SUITE LL12
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5300
Mailing Address - Country:US
Mailing Address - Phone:800-277-4041
Mailing Address - Fax:877-888-2535
Practice Address - Street 1:280 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE LL12
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5300
Practice Address - Country:US
Practice Address - Phone:800-277-4041
Practice Address - Fax:877-888-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty