Healthcare Provider Details

I. General information

NPI: 1790967339
Provider Name (Legal Business Name): SOUTHGATE URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14523 NORTHLINE RD
SOUTHGATE MI
48195-2446
US

IV. Provider business mailing address

L-4380
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 734-324-7800
  • Fax: 734-324-7801
Mailing address:
  • Phone: 734-324-7800
  • Fax: 734-324-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4301065784
License Number StateMI

VIII. Authorized Official

Name: DR. FARAH IFTIKHAR
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 734-324-7800