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General NPI Number Information
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NPI Number | 1336829340
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Entity Type | Organization
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Legal Business Name | 12 AND DEQUINDRE URGENT LLC
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 28373 DEQUINDRE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3003
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Country | US
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Telephone | 248-677-3660
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Fax |
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Provider Business Mailing Address
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Address Line | 28373 DEQUINDRE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3003
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Country | US
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Telephone | 248-677-3660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABDULLATIF ANTOON YALDO
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Credential |
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Telephone | 248-755-1248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty 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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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