=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881048494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YPSILANTI URGENT CARE WALK-IN CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2016
-----------------------------------------------------
Last Update Date | 07/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 W MICHIGAN AVE SUITE 100
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-5450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-948-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 W MICHIGAN AVE
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-5450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-948-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | ABID ABDULLAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-948-3030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | 06858K
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------