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Organization
SOUTHGATE MEDICAL CENTER PLLC
Active
Organization
SOUTHGATE MEDICAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE SLOAN (OFFICE MANAGER)
(734) 284-2090
Entity
Organization
Contact information
Practice address
12815 NORTHLINE RD, SOUTHGATE, MI 48195-1109
(734) 284-2090
(734) 284-9666
Mailing address
12815 NORTHLINE RD, SOUTHGATE, MI 48195-1109
(734) 284-2090
(734) 284-9666
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301089436
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301089436
PHYSICIAN LICENSE
—
Enumeration date
05/11/2012
Last updated
05/11/2012
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