NPIMap

Organization Active NPI

Surburban LLC

  • Family Medicine Physician
  • Southfield, MI
National Provider Identifier
1902036304
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SURBURBAN LLC
Practice address
20905 Greenfield Rd
Suite 203
Southfield, MI 48075-5360
Phone
(313) 837-0560
NPI assigned
Jul 20, 2009
Last updated
Nov 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Authorized official

Name
Ms. Charrisa Nadine Williams
Title
Owner
Phone
(313) 837-0560

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

20905 Greenfield Rd
Suite 203
Southfield, MI 48075-5360

Mailing address

PO Box 760128
Lathrup Village, MI 48076-0128

National Provider Directory

National Provider Directory

Locations

20905 Greenfield Rd
Ste 203
Southfield, MI 48075
Phone (248) 629-9419

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1902036304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 760128",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480760128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20905 GREENFIELD RD",
            "address_2": "SUITE 203",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480755360",
            "telephone_number": "313-837-0560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURBURBAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-20",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CHARRISA",
        "authorized_official_middle_name": "NADINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-837-0560",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.