1124123583 NPI number — DEARBORN URGENT CARE PC

Table of content: (NPI 1124123583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124123583 NPI number — DEARBORN URGENT CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEARBORN 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:
1124123583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32588 06
Provider Second Line Business Mailing Address:
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:
313-846-1700
Provider Business Mailing Address Fax Number:
313-846-8413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5728 SCHAEFER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126-2298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-846-8400
Provider Business Practice Location Address Fax Number:
313-846-8413
Provider Enumeration Date:
09/13/2006

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/MED DIR/PHY
Authorized Official Telephone Number:
313-846-8400

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301065784 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4301065784 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • 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: "N" .

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

  • Identifier: 078773 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 110H229570 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700H229780 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7897882 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com