Healthcare Provider Details

I. General information

NPI: 1114340171
Provider Name (Legal Business Name): CLIO URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4272 W VIENNA RD
CLIO MI
48420-9454
US

IV. Provider business mailing address

4272 W VIENNA RD
CLIO MI
48420
US

V. Phone/Fax

Practice location:
  • Phone: 810-919-9416
  • Fax: 810-686-1687
Mailing address:
  • Phone: 810-919-9415
  • Fax: 810-686-1687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NUSRAT JAVAID
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 810-919-9415