MEDICARE: HEALTHY URGENT CARE WEST BLOOMFIELD

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		MI

General Provider Information

NPI Number	:	1396017026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY URGENT CARE WEST BLOOMFIELD

Provider Business Mailing Address
First Line	:	7125 ORCHARD LAKE RD
Second Line	:	SUITE 100
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3616
Country	:	US
Telephone Number	:	248-865-7444
Fax Number	:	248-865-7469

Provider Business Practice Location Address
First Line	:	7125 ORCHARD LAKE RD
Second Line	:	SUITE 100
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3616
Country	:	US
Telephone Number	:	248-865-7444
Fax Number	:	248-865-7469

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. SARMED G SINAWI
Credential	:	M.D.
Telephone Number	:	248-865-7444

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	03/03/2012

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