Healthcare Provider Details

I. General information

NPI: 1821517491
Provider Name (Legal Business Name): WEST ALLIS URGENT CARE WALK IN CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7516 W OKLAHOMA AVE
MILWAUKEE WI
53219-2860
US

IV. Provider business mailing address

1556 BLACKFOOT AVE APT D
GRAFTON WI
53024-9377
US

V. Phone/Fax

Practice location:
  • Phone: 734-652-2385
  • Fax:
Mailing address:
  • Phone: 734-652-2385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MUHAMMAD IMRAN
Title or Position: CEO
Credential: MD
Phone: 734-652-2385