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General NPI Number Information
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NPI Number | 1144464058
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Entity Type | Organization
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Legal Business Name | NORTHEAST MACOMB URGENT CARE PLLC
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 43900 GARFIELD RD STE 121
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City | CLINTON TWP
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State | MI
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Zip | 48038-1128
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Country | US
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Telephone | 734-402-2000
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Fax | 734-402-2400
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Provider Business Mailing Address
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Address Line | 20000 VICTOR PKWY STE 115
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City | LIVONIA
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State | MI
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Zip | 48152-7029
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Country | US
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Telephone | 734-402-2000
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Fax | 734-402-2400
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. FARAH S IFTIKHAR
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Credential | MD
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Telephone | 734-402-2000
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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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