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General NPI Number Information
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NPI Number | 1063159630
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Entity Type | Organization
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Legal Business Name | MOUND URGENT CARE PLLC
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 31200 MOUND RD
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City | WARREN
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State | MI
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Zip | 48092-4734
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Country | US
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Telephone | 248-850-8395
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Fax | 248-850-8495
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Provider Business Mailing Address
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Address Line | 31200 MOUND RD
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City | WARREN
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State | MI
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Zip | 48092-4734
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Country | US
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Telephone | 248-850-8395
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Fax | 248-850-8495
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Authorized Official
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Title or Position | MANAGER
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Name | FADI DEMASHKIEH
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Credential |
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Telephone | 248-561-1291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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