1083239420 NPI number — DOCTORS URGENT CARE OAKPARK SOUTHFIELD

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 1083239420 NPI number — DOCTORS URGENT CARE OAKPARK SOUTHFIELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS URGENT CARE OAKPARK SOUTHFIELD
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:
1083239420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14671 TELEGRAPH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48239-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-948-3055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23303 GREENFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-3758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-948-3055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MOLNAR
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OPERATIONS MANAGER
Authorized Official Telephone Number:
313-948-3055

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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