Provider Demographics
NPI:1447557848
Name:ANTHONY B SONGCO MD PC
Entity Type:Organization
Organization Name:ANTHONY B SONGCO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SONGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-241-1100
Mailing Address - Street 1:1704 S CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1622
Mailing Address - Country:US
Mailing Address - Phone:734-241-1100
Mailing Address - Fax:734-241-5114
Practice Address - Street 1:1704 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1622
Practice Address - Country:US
Practice Address - Phone:734-241-1100
Practice Address - Fax:734-241-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI045431208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty