1043492689 NPI number — SARATOGA URGENT CARE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043492689 NPI number — SARATOGA URGENT CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARATOGA URGENT CARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043492689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32588
Provider Second Line Business Mailing Address:
07
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48232-0588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-527-4000
Provider Business Mailing Address Fax Number:
313-527-4004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15000 GRATIOT AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48205-1973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-527-4000
Provider Business Practice Location Address Fax Number:
313-527-4004
Provider Enumeration Date:
12/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARSIWALA
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
313-527-4000

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  4301065784 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)