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Contact Information

GEORGE C FOGG, MD, PHD
330 BARCLAY AVE NE
SUITE 203
GRAND RAPIDS, MI49503-2556
 Phone: 616-391-2313
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Infectious Diseases

2080P0208X 37 Physician/Pediatric Medicine
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for GEORGE C FOGG · (Male)

NPI # 1811901085
Status Active
Credentials MD, PHD
Entity Individual
Enumeration date 07/27/2006
Last updated 03/17/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • MI License # 4301078543
  • MI Medicaid 4627622
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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