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Organization
SOUTHEAST MICHIGAN MEDICAL ASSOCIATES PC
Active
Organization
SOUTHEAST MICHIGAN MEDICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHOK KUMAR BANSAL M.D. (PRESIDENT)
(248) 827-7612
Entity
Organization
Contact information
Practice address
18451 W 12 MILE RD, STE 200, LATHRUP VILLAGE, MI 48076-2644
(248) 827-7612
(248) 827-7615
Mailing address
18451 W 12 MILE RD, STE 200, LATHRUP VILLAGE, MI 48076-2644
(248) 827-7612
(248) 827-7615
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301057441
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1106306332
BCBSM
MI
05
—
3150549
—
MI
Enumeration date
01/23/2007
Last updated
02/21/2017
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