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General NPI Number Information
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NPI Number | 1063120244
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Entity Type | Organization
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Legal Business Name | ULTIMATE MEDICAL CARE PLC
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 20755 GREENFIELD RD STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5400
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Country | US
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Telephone | 947-282-5009
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Fax | 248-809-2319
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Provider Business Mailing Address
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Address Line | 23031 WREXFORD DR
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City | SOUTHFIELD
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State | MI
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Zip | 48033-6575
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Country | US
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Telephone | 248-417-9822
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DERRICK WILLIAMSON
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Credential | DO
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Telephone | 947-282-5009
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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 |
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License Number State |
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