Healthcare Provider Details

I. General information

NPI: 1710736277
Provider Name (Legal Business Name): LIFE MEDICAL CENTER URGENT CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25325 FORD RD STE 200
DEARBORN MI
48128-1086
US

IV. Provider business mailing address

25325 FORD RD STE 200
DEARBORN MI
48128-1086
US

V. Phone/Fax

Practice location:
  • Phone: 313-887-7774
  • Fax:
Mailing address:
  • Phone: 313-887-7774
  • Fax:

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: MOHAMED ELDIRANI
Title or Position: PRESIDENT
Credential: MD
Phone: 248-215-0048