| Southgate Medical Center Pllc | |
|
12815 Northline Rd Southgate MI 48195-1109 | |
| (734) 284-2090 | |
| (734) 284-9666 |
| Full Name | Southgate Medical Center Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12815 Northline Rd, Southgate, Michigan |
| Authorized Official Name and Position | Julie Sloan (OFFICE MANAGER) |
| Authorized Official Contact | 7342842090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southgate Medical Center Pllc 12815 Northline Rd Southgate MI 48195-1109 Ph: (734) 284-2090 | Southgate Medical Center Pllc 12815 Northline Rd Southgate MI 48195-1109 Ph: (734) 284-2090 |
| NPI Number | 1801155858 |
|---|---|
| Provider Enumeration Date | 05/11/2012 |
| Last Update Date | 05/11/2012 |
| Medicare PECOS PAC ID | 2264688621 |
|---|---|
| Medicare Enrollment ID | O20120820000168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801155858 | NPI | - | NPPES |
| 4301089436 | Other | PHYSICIAN LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301089436 (Michigan) | Primary |
| Provider Name | Bahae M Ebrahem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508059072 PECOS PAC ID: 1951490903 Enrollment ID: I20071129000059 |
| Provider Name | Amal M Abdul Hussein |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083814420 PECOS PAC ID: 3274607262 Enrollment ID: I20080808000809 |
A.m. Mussani, Md., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12815 Northline Rd, Southgate, MI 48195 Phone: 734-284-2090 Fax: 734-284-9666 | |
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