MEDICARE: MEDPRO URGENT CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1093388159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPRO URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	31005 JOHN R RD STE A
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1907
Country	:	US
Telephone Number	:	248-850-8306
Fax Number	:

Provider Business Practice Location Address
First Line	:	31005 JOHN R RD STE A
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1907
Country	:	US
Telephone Number	:	248-850-8306
Fax Number	:	248-808-6711

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JOSHUA RUEDISUELI
Credential	:	PA
Telephone Number	:	248-850-8306

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	09/06/2023

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