1477552149 NPI number — MICHIGAN URGENT AND PRIMARY CARE

Table of content: (NPI 1477552149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477552149 NPI number — MICHIGAN URGENT AND PRIMARY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN URGENT AND PRIMARY CARE
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:
LIVONIA URGENT CARE
Provider Other Organization Name Type Code:
3
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:
1477552149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17197 N LAUREL PARK DR
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48152-2680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-338-8300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37595 7 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48152-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-542-6100
Provider Business Practice Location Address Fax Number:
734-542-6102
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ARSIWALA
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
734-542-6100

Provider Taxonomy Codes

  • 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: 4301075100 , 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: 010H270150 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11009 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: I19418 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 47730 . This is a "OMNICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700H215310 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 146039 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 50014703 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 124756 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 6467A . This is a "CAPE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 023865 . This is a "MIDWEST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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