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NPI Code Detail

MEDICARE: ICARE URGENT CARE PLLC

MEDICARE: ICARE 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
1261QU0200XUrgent Care Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255083366
Entity Type Code : Organization
Provider Name (Legal Business Name) : ICARE URGENT CARE PLLC
Provider Business Mailing Address
First Line : 32320 MICHIGAN AVE
Second Line :
City : WAYNE
State : MI
Zip : 48184-1423
Country : US
Telephone Number : 313-578-1911
Fax Number :
Provider Business Practice Location Address
First Line : 23850 VAN BORN RD STE B
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-2325
Country : US
Telephone Number : 313-278-7750
Fax Number :
Authorized Official
Title or Position : AUTHOROIZED OFFICIAL
Name : FAHTME ABDALLAH
Credential :
Telephone Number : 313-623-3975
Provider Enumeration Date : 01/20/2022
Last Update Date : 04/12/2023

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