Healthcare Provider Details

I. General information

NPI: 1972503902
Provider Name (Legal Business Name): WARREN URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 VAN DYKE AVE
WARREN MI
48093-7949
US

IV. Provider business mailing address

L-4372
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 586-276-8200
  • Fax: 586-276-8181
Mailing address:
  • Phone: 586-276-8200
  • Fax: 586-276-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301065784
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4301065784
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301065784
License Number StateMI

VIII. Authorized Official

Name: DR. FARAH IFTIKHAR
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 586-276-8200