| South Oakland Gastroenterology Associates Pc | |
|
28080 Grand River Ave Suite 306 Farmington Hills MI 48336-5966 | |
| (248) 471-8982 | |
| (248) 471-9978 |
| Full Name | South Oakland Gastroenterology Associates Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 28080 Grand River Ave, Farmington Hills, Michigan |
| Authorized Official Name and Position | Michael A Biederman (PRESIDENT) |
| Authorized Official Contact | 2484718982 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Oakland Gastroenterology Associates Pc Dept 203901 P O Box 67000 Detroit MI 48267-0001 Ph: (248) 471-8982 | South Oakland Gastroenterology Associates Pc 28080 Grand River Ave Suite 306 Farmington Hills MI 48336-5966 Ph: (248) 471-8982 |
| NPI Number | 1316919616 |
|---|---|
| Provider Enumeration Date | 02/02/2006 |
| Last Update Date | 01/13/2016 |
| Medicare PECOS PAC ID | 3274578661 |
|---|---|
| Medicare Enrollment ID | O20050627000354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316919616 | NPI | - | NPPES |
| 1316919616 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 5101006198 (Michigan) | Primary |
| Provider Name | Mariquit D Sendelbach |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1457563488 PECOS PAC ID: 8426109877 Enrollment ID: I20090625000402 |
| Provider Name | Katie H Macfarlane |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548491129 PECOS PAC ID: 8325277601 Enrollment ID: I20140827001515 |
| Provider Name | Richard S Kinsey |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1659574127 PECOS PAC ID: 3476616624 Enrollment ID: I20141216001302 |
| Provider Name | Ehab Rabaa |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1164586707 PECOS PAC ID: 6204937568 Enrollment ID: I20150109000488 |
| Provider Name | Jolian Sam Kathawa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083065916 PECOS PAC ID: 7416248216 Enrollment ID: I20200424001012 |
| Provider Name | Olga Brushaber |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1306259627 PECOS PAC ID: 0941520597 Enrollment ID: I20200610003001 |
| Provider Name | Jared Grodman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1013404540 PECOS PAC ID: 2961766464 Enrollment ID: I20240710002681 |
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