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General NPI Number Information
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NPI Number | 1033231667
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Entity Type | Organization
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Legal Business Name | WESTERN WAYNE URGENT CARE PC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 2050 N HAGGERTY RD SUITE 140
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City | CANTON
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State | MI
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Zip | 48187-3795
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Country | US
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Telephone | 734-259-0500
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Fax | 734-259-0505
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Provider Business Mailing Address
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Address Line | PO BOX 32588 08
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City | DETROIT
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State | MI
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Zip | 48232
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Country | US
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Telephone | 734-259-0500
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Fax | 734-259-0505
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHAMMED A ARSIWALA
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Credential | MD
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Telephone | 734-259-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301065784
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 4301075100
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301065784
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License Number State | MI
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