Healthcare Provider Details

I. General information

NPI: 1851636328
Provider Name (Legal Business Name): TRUST CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 BALDWIN RD
LAPEER MI
48446-3007
US

IV. Provider business mailing address

5022 RIFLE RIVER TRL
ALGER MI
48610-9327
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-3811
  • Fax:
Mailing address:
  • Phone: 989-345-2068
  • Fax: 989-345-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4301079461
License Number StateMI

VIII. Authorized Official

Name: DR. HATEM M ATAYA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 989-345-2068