Provider Demographics
NPI:1962597906
Name:SONGCO, ANTHONY B (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:SONGCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 S CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9775
Mailing Address - Country:US
Mailing Address - Phone:734-241-2362
Mailing Address - Fax:
Practice Address - Street 1:4031 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9775
Practice Address - Country:US
Practice Address - Phone:734-241-2362
Practice Address - Fax:734-777-9065
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1621287Medicaid
MI1621287Medicaid
0585958Medicare ID - Type Unspecified