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General NPI Number Information
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NPI Number | 1134357171
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Entity Type | Organization
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Legal Business Name | SOUTH ALLEN MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 21090 ALLEN RD
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City | WOODHAVEN
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State | MI
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Zip | 48183-1602
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Country | US
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Telephone | 734-676-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 22673 ALLEN RD SUITE 300
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City | WOODHAVEN
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State | MI
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Zip | 48183-2272
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Country | US
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Telephone | 734-676-9800
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Fax | 734-676-9801
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Authorized Official
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Title or Position | PHYSICIAN
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Name | NADER DEMERI
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Credential | MD
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Telephone | 734-676-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301082223
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License Number State | MI
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