Provider Demographics
NPI:1760573075
Name:SOUTHFIELD INTERNISTS PC
Entity Type:Organization
Organization Name:SOUTHFIELD INTERNISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRATIBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-559-0900
Mailing Address - Street 1:16800 W 12 MILE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6334
Mailing Address - Country:US
Mailing Address - Phone:248-559-0900
Mailing Address - Fax:248-559-0011
Practice Address - Street 1:16800 W 12 MILE RD
Practice Address - Street 2:STE 205
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6334
Practice Address - Country:US
Practice Address - Phone:248-559-0900
Practice Address - Fax:248-559-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F31723OtherBCBSM
MI0F31723OtherBCBSM