Healthcare Provider Details

I. General information

NPI: 1841043783
Provider Name (Legal Business Name): 24 HOUR LIFELINE MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12640 E 12 MILE RD
WARREN MI
48093-3520
US

IV. Provider business mailing address

12640 E 12 MILE RD
WARREN MI
48093-3520
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-2020
  • Fax: 586-745-1756
Mailing address:
  • Phone: 586-751-2020
  • Fax: 586-745-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily 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: AMBER FLINT
Title or Position: OFFICE MANAGER
Credential:
Phone: 586-300-9184