Healthcare Provider Details

I. General information

NPI: 1841299435
Provider Name (Legal Business Name): WOODLAND URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22341 W 8 MILE RD
DETROIT MI
48219-1217
US

IV. Provider business mailing address

L-4377
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 313-387-8700
  • Fax: 313-387-7665
Mailing address:
  • Phone: 313-387-8700
  • Fax: 313-387-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301065784
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301065784
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4301075100
License Number StateMI

VIII. Authorized Official

Name: DR. FARAH IFTIKHAR
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 313-387-8700