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General NPI Number Information
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NPI Number | 1760708499
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Entity Type | Organization
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Legal Business Name | CLARKSTON URGENT CARE PLC
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 5701 BOW POINTE DR SUITE 120
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City | CLARKSTON
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State | MI
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Zip | 48346-3198
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Country | US
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Telephone | 248-625-2273
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Fax | 248-625-6336
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Provider Business Mailing Address
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Address Line | 5701 BOW POINTE DR SUITE 120
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City | CLARKSTON
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State | MI
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Zip | 48346-3198
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Country | US
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Telephone | 248-625-2273
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Fax | 248-625-6336
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY R ONEILL
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Credential | DO
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Telephone | 248-625-2621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301048260
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 5101011123
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101009832
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 5101011134
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301074879
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License Number State | MI
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