MEDICARE: HOPE URGENT CARE LATINO 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	:	1497020424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE URGENT CARE LATINO PLLC

Provider Business Mailing Address
First Line	:	9171 LAPEER RD
Second Line	:	STE 100
City	:	DAVISON
State	:	MI
Zip	:	48423-3617
Country	:	US
Telephone Number	:	810-412-5590
Fax Number	:	810-412-5593

Provider Business Practice Location Address
First Line	:	503 W GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-2200
Country	:	US
Telephone Number	:	810-412-5590
Fax Number	:	810-412-5593

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NUSRAT JAVAID
Credential	:	M.D
Telephone Number	:	810-412-5590

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/08/2012

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