Healthcare Provider Details

I. General information

NPI: 1487880555
Provider Name (Legal Business Name): NORTHEAST MACOMB URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43900 GARFIELD ROAD STE #121 NORTHEAST MACOMB URGENT CARE PLLC
CLINTON TWP MI
48038-1137
US

IV. Provider business mailing address

33405 W. 12 MILE ROAD STE #173 URGENT CARE MANAGEMENT
FARMINGTON HILLS MI
48331
US

V. Phone/Fax

Practice location:
  • Phone: 734-402-2000
  • Fax: 734-402-2400
Mailing address:
  • Phone: 734-402-2000
  • Fax: 734-402-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number7301063833
License Number StateMI

VIII. Authorized Official

Name: MRS. FARAH S IFTIKHAR
Title or Position: MEMBER
Credential: MD
Phone: 734-402-2000