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General NPI Number Information
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NPI Number | 1114656576
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Entity Type | Organization
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Legal Business Name | PIONEER MEDICAL AND URGENT CARE PLLC
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 6675 ROCKDALE ST
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City | DEARBORN HTS
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State | MI
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Zip | 48127-4342
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Country | US
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Telephone | 313-330-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 26200 FORD RD UNIT 908
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City | DEARBORN HTS
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State | MI
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Zip | 48127-4342
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Country | US
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Telephone | 313-330-0033
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Fax |
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Authorized Official
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Title or Position | OWNER PROVIDER
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Name | MOHAMAD EL ADBALLAH
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Credential | M.D.
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Telephone | 313-330-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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