MEDICARE: FAMILY DOC CLINIC AND URGENT CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104406289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DOC CLINIC AND URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	25350 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2102
Country	:	US
Telephone Number	:	313-914-3666
Fax Number	:	313-380-0672

Provider Business Practice Location Address
First Line	:	25350 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2102
Country	:	US
Telephone Number	:	313-914-3666
Fax Number	:	313-380-0672

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALI IBRAHIM NASRALLAH
Credential	:	MD
Telephone Number	:	313-914-3666

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/15/2026

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Directions to “FAMILY DOC CLINIC AND URGENT CARE PLLC ” Practice Location

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