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General NPI Number Information
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NPI Number | 1396351037
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Entity Type | Organization
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Legal Business Name | MYNA
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 388 INKSTER RD
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City | INKSTER
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State | MI
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Zip | 48141-1209
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Country | US
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Telephone | 734-716-5901
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Fax | 248-658-8777
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Provider Business Mailing Address
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Address Line | 23647 PADDOCK DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-2227
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Country | US
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Telephone | 734-716-5901
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Fax | 248-658-8777
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MANAL OMAR
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Credential | DO
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Telephone | 734-716-5901
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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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