Healthcare Provider Details

I. General information

NPI: 1164756417
Provider Name (Legal Business Name): UNITED FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12170 CONANT ST SUITE C-2
DETROIT MI
48212-4137
US

IV. Provider business mailing address

454 E SOUTH BLVD
TROY MI
48085-1265
US

V. Phone/Fax

Practice location:
  • Phone: 313-366-9800
  • Fax:
Mailing address:
  • Phone: 586-604-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number4301079852
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4301079852
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4301079852
License Number StateMI

VIII. Authorized Official

Name: DR. SHAZIA WADOOD
Title or Position: PROPRITOR
Credential: M.D
Phone: 586-604-8108