Organization
EMERGENCY DEPARTMENT PHYSICIANS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY C. SOUTHALL M.D. (PRESIDENT)
(586) 294-0600
Entity
Organization
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 573-5000
Mailing address
17717 MASONIC, FRASER, MI 48026-3158
(586) 294-0600
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
09/07/2012
Last updated
02/27/2013
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