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General NPI Number Information
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NPI Number | 1568931897
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Entity Type | Organization
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Legal Business Name | SOUTHFIELD PREMIER URGENT CARE AND WALK-IN CLINIC PLLC
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Dates
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Enumeration Date | 11/15/2018
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Last Update Date | 07/05/2020
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Provider Practice Location Address
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Address Line | 17070 W 12 MILE RD STE A
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2116
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Country | US
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Telephone | 248-559-2280
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Fax | 248-559-3752
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Provider Business Mailing Address
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Address Line | 17070 W 12 MILE RD STE A
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2116
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Country | US
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Telephone | 248-559-2280
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Fax | 248-559-3752
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Authorized Official
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Title or Position | PHYSICIAN/MEDICAL DIRECTOR
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Name | RAFID Y MANSOUR
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Credential | MD
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Telephone | 248-559-2280
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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