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General NPI Number Information
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NPI Number | 1528457363
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Entity Type | Organization
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Legal Business Name | KEYSTONE URGENT CARE P.C.
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 5097 MILLER RD
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City | FLINT
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State | MI
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Zip | 48507-1043
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Country | US
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Telephone | 810-877-8130
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Fax | 810-275-6703
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Provider Business Mailing Address
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Address Line | 5097 MILLER RD
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City | FLINT
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State | MI
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Zip | 48507-1043
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Country | US
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Telephone | 810-877-8130
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Fax | 810-275-6703
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HATEM M ATAYA
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Credential | M.D.
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Telephone | 810-877-7130
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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 | 4301079461
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License Number State | MI
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