1487880555 NPI number — NORTHEAST MACOMB URGENT CARE PLLC

Table of content: (NPI 1487880555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487880555 NPI number — NORTHEAST MACOMB URGENT CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST MACOMB URGENT CARE PLLC
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:
1487880555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33405 W. 12 MILE ROAD
Provider Second Line Business Mailing Address:
STE #173 URGENT CARE MANAGEMENT
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-402-2000
Provider Business Mailing Address Fax Number:
734-402-2400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43900 GARFIELD ROAD
Provider Second Line Business Practice Location Address:
STE #121 NORTHEAST MACOMB URGENT CARE PLLC
Provider Business Practice Location Address City Name:
CLINTON TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-402-2000
Provider Business Practice Location Address Fax Number:
734-402-2400
Provider Enumeration Date:
06/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
IFTIKHAR
Authorized Official First Name:
FARAH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
734-402-2000

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  7301063833 , 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)





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