Organization
SOUTHGATE CT, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS PAUL VOLLMAN DO (PRESIDENT)
(734) 281-6600
Entity
Organization
Contact information
Practice address
15304 TRENTON RD, SOUTHGATE, MI 48195-2027
(734) 281-6600
Mailing address
15304 TRENTON RD, SOUTHGATE, MI 48195-2027
(734) 281-6600
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000003984
CAPE MEDICAL
MI
01
—
028642
MIDWEST HEALTH PLAN
MI
01
—
0H22339
BLUE CROSS BLUE SHIELD MI
MI
01
—
0Q26265
HAP
MI
01
—
141261
PREFERRED CHOICES
MI
01
—
7588661
AETNA
MI
01
—
DC6466
RAILROAD MEDICARE
MI
01
—
L182034
M-CARE
MI
Enumeration date
07/18/2006
Last updated
08/22/2020
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