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General NPI Number Information
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NPI Number | 1285051813
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Entity Type | Organization
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Legal Business Name | SOUTH BLVD WALK-IN CLINIC PLLC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 2191 SOUTH BLVD
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City | AUBURN HILLS
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State | MI
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Zip | 48326-3481
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Country | US
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Telephone | 248-724-1420
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Fax | 248-724-1430
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Provider Business Mailing Address
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Address Line | 2191 SOUTH BLVD
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City | AUBURN HILLS
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State | MI
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Zip | 48326-3481
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Country | US
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Telephone | 248-724-1420
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Fax | 248-724-1430
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Authorized Official
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Title or Position | OWNER
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Name | DR. HORIA M. TATU
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Credential | M.D.
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Telephone | 248-202-2022
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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 | 4301080465
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License Number State | MI
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