Provider Demographics
NPI:1619034071
Name:SOUTHGATE MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:SOUTHGATE MEDICAL GROUP, PLLC
Other - Org Name:SCHAFER FARMS MEDICAL GROUP, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMIL
Authorized Official - Last Name:NESHEWAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-283-3222
Mailing Address - Street 1:3 HERITAGE CENTER
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195
Mailing Address - Country:US
Mailing Address - Phone:734-283-3222
Mailing Address - Fax:734-283-4006
Practice Address - Street 1:3 HERITAGE CENTER
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195
Practice Address - Country:US
Practice Address - Phone:734-283-3222
Practice Address - Fax:734-283-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty