Healthcare Provider Details

I. General information

NPI: 1508471418
Provider Name (Legal Business Name): WATERLOO URGENT CARE WALK IN CLINIC COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ILLINOIS ROUTE 3
WATERLOO IL
62298
US

IV. Provider business mailing address

14671 TELEGRAPH RD
REDFORD MI
48239-3300
US

V. Phone/Fax

Practice location:
  • Phone: 313-948-3055
  • Fax: 248-250-6430
Mailing address:
  • Phone: 131-394-8305
  • Fax: 313-948-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY MOLNAR
Title or Position: BUSINESS OPERATIONS MANAGER
Credential:
Phone: 313-948-3055