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General NPI Number Information
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NPI Number | 1326703208
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Entity Type | Organization
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Legal Business Name | GTUC-MICHIGAN PC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 6601 LEWIS AVE
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City | TEMPERANCE
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State | MI
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Zip | 48182-1209
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Country | US
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Telephone | 734-206-2016
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 631545
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City | CINCINNATI
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State | OH
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Zip | 45263-1545
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Country | US
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Telephone | 859-291-4800
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Fax | 833-694-1507
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALID MAHMOUD
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Credential | MD
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Telephone | 734-206-2016
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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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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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