Healthcare Provider Details

I. General information

NPI: 1326703208
Provider Name (Legal Business Name): GTUC-MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 LEWIS AVE
TEMPERANCE MI
48182-1209
US

IV. Provider business mailing address

PO BOX 631545
CINCINNATI OH
45263-1545
US

V. Phone/Fax

Practice location:
  • Phone: 734-206-2016
  • Fax:
Mailing address:
  • Phone: 859-291-4800
  • Fax: 833-694-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WALID MAHMOUD
Title or Position: PRESIDENT
Credential: MD
Phone: 734-206-2016