Healthcare Provider Details

I. General information

NPI: 1063120244
Provider Name (Legal Business Name): ULTIMATE MEDICAL CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20755 GREENFIELD RD STE 100
SOUTHFIELD MI
48075-5400
US

IV. Provider business mailing address

23031 WREXFORD DR
SOUTHFIELD MI
48033-6575
US

V. Phone/Fax

Practice location:
  • Phone: 947-282-5009
  • Fax: 248-809-2319
Mailing address:
  • Phone: 248-417-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DERRICK WILLIAMSON
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 947-282-5009