Provider Demographics
NPI:1881620235
Name:SOUTHFIELD MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:SOUTHFIELD MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIYADH
Authorized Official - Middle Name:P
Authorized Official - Last Name:KASMIKHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-440-2185
Mailing Address - Street 1:28500 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2722
Mailing Address - Country:US
Mailing Address - Phone:248-440-2185
Mailing Address - Fax:248-440-2189
Practice Address - Street 1:28500 SOUTHFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2722
Practice Address - Country:US
Practice Address - Phone:248-440-2185
Practice Address - Fax:248-440-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty