Provider Demographics
NPI:1023036936
Name:SOUTHGATE CT, PLC
Entity Type:Organization
Organization Name:SOUTHGATE CT, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-281-6600
Mailing Address - Street 1:15304 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2027
Mailing Address - Country:US
Mailing Address - Phone:734-281-6600
Mailing Address - Fax:
Practice Address - Street 1:15304 TRENTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2027
Practice Address - Country:US
Practice Address - Phone:734-281-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI028642OtherMIDWEST HEALTH PLAN
MI0H22339OtherBLUE CROSS BLUE SHIELD MI
MI141261OtherPREFERRED CHOICES
MIDC6466OtherRAILROAD MEDICARE
MI000000003984OtherCAPE MEDICAL
MI0Q26265OtherHAP
MI7588661OtherAETNA
MIL182034OtherM-CARE
MI0H22339OtherBLUE CROSS BLUE SHIELD MI