# MONGKOL MONG, M.D.P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316079452
- **Authorized official:** DR. MONGKOL MONGKOLPRADIT M.D. (PRESIDENT)
- **Authorized official phone:** (734) 285-2255

## Contact information

- **Practice address:** 15332 FORT ST, SOUTHGATE, MI 48195-1304
- **Practice address phone:** (734) 285-2255
- **Practice address fax:** (734) 285-9044
- **Mailing address:** 15332 FORT ST, SOUTHGATE, MI 48195-1304
- **Mailing address phone:** (734) 285-2255
- **Mailing address fax:** (734) 285-9044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MM032063 | MI | Yes |

## Other

- **Enumeration date:** 03/12/2007
- **Last updated:** 08/22/2020