1609346766 NPI number — MICHIGAN URGENT CARE

Table of content: (NPI 1609346766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609346766 NPI number — MICHIGAN URGENT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN URGENT 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:
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:
1609346766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
760 OLD ROSWELL RD STE 117
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-8685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-704-8875
Provider Business Mailing Address Fax Number:
888-840-1265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 EUREKA RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYANDOTTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48192-5839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-225-9300
Provider Business Practice Location Address Fax Number:
734-225-9305
Provider Enumeration Date:
12/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ARSIWALA
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
734-338-8300

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1982060935 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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