Healthcare Provider Details

I. General information

NPI: 1568931897
Provider Name (Legal Business Name): SOUTHFIELD PREMIER URGENT CARE AND WALK-IN CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 07/05/2020
Certification Date: 07/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17070 W 12 MILE RD STE A
SOUTHFIELD MI
48076-2116
US

IV. Provider business mailing address

17070 W 12 MILE RD STE A
SOUTHFIELD MI
48076-2116
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-2280
  • Fax: 248-559-3752
Mailing address:
  • Phone: 248-559-2280
  • Fax: 248-559-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAFID Y MANSOUR
Title or Position: PHYSICIAN/MEDICAL DIRECTOR
Credential: MD
Phone: 248-559-2280