| Southfort Family Clinic Pc | |
|
13650 Fort St Southgate MI 48195-1152 | |
| (734) 281-2150 | |
| Not Available |
| Full Name | Southfort Family Clinic Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 13650 Fort St, Southgate, Michigan |
| Authorized Official Name and Position | Edward Nazareno (PRESIDENT) |
| Authorized Official Contact | 7342812150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southfort Family Clinic Pc 13650 Fort St Southgate MI 48195-1152 Ph: (734) 281-2150 | Southfort Family Clinic Pc 13650 Fort St Southgate MI 48195-1152 Ph: (734) 281-2150 |
| NPI Number | 1184801318 |
|---|---|
| Provider Enumeration Date | 01/30/2008 |
| Last Update Date | 01/30/2008 |
| Medicare PECOS PAC ID | 9931284817 |
|---|---|
| Medicare Enrollment ID | O20080318000073 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184801318 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301067719 (Michigan) | Primary |
| Provider Name | Edward I Nazareno |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679645972 PECOS PAC ID: 2769567643 Enrollment ID: I20080318000064 |
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