Southfield Family Physicians, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MJ034283 Issued in MI

Legal business name

SOUTHFIELD FAMILY PHYSICIANS, PLLC

Practice address

22972 Lahser Rd
Southfield, MI 48034-4408

Phone

(248) 353-4777

Fax

(248) 353-4235

NPI assigned

Mar 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jackie Gabbanajan, RN

Title

Office Manager

Phone

(242) 353-4777

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330387200000",
    "number": "1720118037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22972 LAHSER RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480334408",
            "telephone_number": "248-353-4777",
            "fax_number": "248-353-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22972 LAHSER RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480344408",
            "telephone_number": "248-353-4777",
            "fax_number": "248-353-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFIELD FAMILY PHYSICIANS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2012-02-28",
        "status": "A",
        "authorized_official_last_name": "GABBANAJAN",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "242-353-4777",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "MJ034283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "080F375520",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4102457",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.