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General NPI Number Information
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NPI Number | 1972852705
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Entity Type | Organization
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Legal Business Name | ELITE URGENT CARE PLLC
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 15301 TIREMAN AVE STE-A
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City | DEARBORN
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State | MI
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Zip | 48126-1045
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Country | US
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Telephone | 313-736-5004
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Fax |
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Provider Business Mailing Address
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Address Line | 5293 HARTWELL ST
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City | DEARBORN
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State | MI
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Zip | 48126-3309
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Country | US
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Telephone | 313-736-5004
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARYAM M MIHTAR
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Credential | RMA
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Telephone | 313-736-5004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 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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