Basic Information
| Provider Information | |||||||||
| NPI: | 1184696494 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHFIELD GASTROENTEROLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28801 PLYMOUTH RD | ||||||||
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| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481502385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342662780 | ||||||||
| FaxNumber: | 7344669615 | ||||||||
| Practice Location | |||||||||
| Address1: | 22250 PROVIDENCE DR | ||||||||
| Address2: | SUITE 406 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485596370 | ||||||||
| FaxNumber: | 2485595338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GELZAYED | ||||||||
| AuthorizedOfficialFirstName: | BRADFORD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7342662780 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.