MEDICARE: MAXEM HEALTH URGENT CARE MADISON HEIGHTS

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1487137170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXEM HEALTH URGENT CARE MADISON HEIGHTS

Provider Business Mailing Address
First Line	:	PO BOX 1248
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39566-1248
Country	:	US
Telephone Number	:	228-223-1927
Fax Number	:

Provider Business Practice Location Address
First Line	:	32600 JOHN R RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1338
Country	:	US
Telephone Number	:	228-223-1927
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RONNIE ALI
Credential	:	DO
Telephone Number	:	707-319-5068

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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