Healthcare Provider Details

I. General information

NPI: 1336829340
Provider Name (Legal Business Name): 12 AND DEQUINDRE URGENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28373 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3003
US

IV. Provider business mailing address

28373 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3003
US

V. Phone/Fax

Practice location:
  • Phone: 248-677-3660
  • Fax:
Mailing address:
  • Phone: 248-677-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABDULLATIF ANTOON YALDO
Title or Position: OWNER
Credential:
Phone: 248-755-1248