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Organization
SOUTHGATE ALLIED ANESTHESIA PLLC
Active
Organization
SOUTHGATE ALLIED ANESTHESIA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ATIF BAWAHAB (ADMIN)
(979) 574-7109
Entity
Organization
Contact information
Practice address
13460 FORT ST, SOUTHGATE, MI 48195-1138
(313) 263-5961
(313) 263-5963
Mailing address
PO BOX 2071, SOUTHGATE, MI 48195-4071
(313) 263-5961
(313) 263-5963
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
4704090801
MI
Other
Enumeration date
10/24/2015
Last updated
10/24/2015
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