Basic Information
| Provider Information | |||||||||
| NPI: | 1881996197 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROINTESTINAL AND LIVER DISORDERS SPECIALISTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27200 LAHSER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480342137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482089257 | ||||||||
| FaxNumber: | 2482089217 | ||||||||
| Practice Location | |||||||||
| Address1: | 27200 LAHSER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480342137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482089257 | ||||||||
| FaxNumber: | 2482089217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2010 | ||||||||
| LastUpdateDate: | 02/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | SIDDIQUI | ||||||||
| AuthorizedOfficialFirstName: | FIRDOUS | ||||||||
| AuthorizedOfficialMiddleName: | ANJUM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2482089257 | ||||||||
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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 | 4301060352 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.