# SOUTHGATE ALLIED ANESTHESIA PLLC

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

## Provider details

- **NPI number:** 1689046070
- **Authorized official:** ATIF BAWAHAB (ADMIN)
- **Authorized official phone:** (979) 574-7109

## Contact information

- **Practice address:** 13460 FORT ST, SOUTHGATE, MI 48195-1138
- **Practice address phone:** (313) 263-5961
- **Practice address fax:** (313) 263-5963
- **Mailing address:** PO BOX 2071, SOUTHGATE, MI 48195-4071
- **Mailing address phone:** (313) 263-5961
- **Mailing address fax:** (313) 263-5963

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367H00000X | Anesthesiologist Assistant | 4704090801 | MI | Yes |

## Other

- **Enumeration date:** 10/24/2015
- **Last updated:** 10/24/2015