Healthcare Provider Details

I. General information

NPI: 1386139913
Provider Name (Legal Business Name): SOUTHFIELD PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28500 SOUTHFIELD RD STE 100
LATHRUP VILLAGE MI
48076-2722
US

IV. Provider business mailing address

28500 SOUTHFIELD RD STE 100
LATHRUP VILLAGE MI
48076-2722
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-0160
  • Fax: 248-557-1756
Mailing address:
  • Phone: 248-557-0160
  • Fax: 248-557-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number046484
License Number StateMI

VIII. Authorized Official

Name: DR. SAMIRA ZEBARI
Title or Position: PHYSICIAN
Credential: MD
Phone: 248-557-0160