# BELLAVISTA MEDICAL CENTER PLLC

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

## Provider details

- **NPI number:** 1447499736
- **Authorized official:** DR. MOHAMAD AL-JARRAH M.D (OWNER)
- **Authorized official phone:** (734) 282-3236

## Contact information

- **Practice address:** 15830 FORT ST, SUITE 7, SOUTHGATE, MI 48195-1367
- **Practice address phone:** (734) 282-3236
- **Practice address fax:** (734) 282-4899
- **Mailing address:** 15830 FORT ST, SUITE 7, SOUTHGATE, MI 48195-1367
- **Mailing address phone:** (734) 282-3236
- **Mailing address fax:** (734) 282-4899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 4301057471 | MI | Yes |

## Other

- **Enumeration date:** 02/11/2009
- **Last updated:** 06/18/2013