Healthcare Provider Details

I. General information

NPI: 1326543240
Provider Name (Legal Business Name): EXPRESS DOCS URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13739 S HURON RIVER DR
ROMULUS MI
48174
US

IV. Provider business mailing address

2931 PHEASANT RING DR
ROCHESTER HILLS MI
48309-2858
US

V. Phone/Fax

Practice location:
  • Phone: 734-941-0895
  • Fax:
Mailing address:
  • Phone: 248-703-5659
  • 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: JOHN-MINA IBRAHIM
Title or Position: PARTNER
Credential: M.D.
Phone: 248-703-5659