Individual
DR. ATHANASIUS Z LOBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22250 PROVIDENCE DR, SUITE 206, SOUTHFIELD, MI 48075-4825
(248) 569-0288
(248) 569-0520
Mailing address
22250 PROVIDENCE DR, SUITE 206, SOUTHFIELD, MI 48075-4825
(248) 569-0288
(248) 569-0520
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
430103354
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0637609
BCBS INDIVIDUAL
MI
01
—
110175608
RR MEDICARE
MI
05
—
129571896
—
MI
01
—
700F314390
BLUE SHIELD
MI
Enumeration date
12/06/2005
Last updated
02/17/2011
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