Basic Information
Provider Information
NPI: 1235120403
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAHER
FirstName: GEORGE
MiddleName: MICHAEL
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5074
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571175074
CountryCode: US
TelephoneNumber: 6053286585
FaxNumber: 6053286512
Practice Location
Address1: 1600 W 22ND ST
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571051521
CountryCode: US
TelephoneNumber: 6053286585
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/04/2005
LastUpdateDate: 02/16/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/16/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0207X02001713AINN Allopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
2080P0207X8469SDY Allopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology

No ID Information.


Home