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General NPI Number Information
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NPI Number | 1679026397
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Entity Type | Organization
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Legal Business Name | CTUC02 URGENT CARE PC
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 1030 BOULEVARD
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1801
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Country | US
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Telephone | 860-986-6440
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 BOULEVARD
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1801
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Country | US
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Telephone | 860-986-6440
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. IFTIKHAR ALI
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Credential | M.D.
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Telephone | 860-986-6440
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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 | 047019
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License Number State | CT
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