Healthcare Provider Details

I. General information

NPI: 1174875140
Provider Name (Legal Business Name): PRIMECARE URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39555 W 10 MILE RD SUITE 301
NOVI MI
48375-2950
US

IV. Provider business mailing address

39555 W 10 MILE RD SUITE 301
NOVI MI
48375-2950
US

V. Phone/Fax

Practice location:
  • Phone: 248-426-7200
  • Fax:
Mailing address:
  • Phone:
  • 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: THEODORE SHIVELY
Title or Position: OWNER
Credential: D.O
Phone: 248-755-2274