MEDICARE: WEST PARK MEDICAL CLINIC PC

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	:	1538704218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PARK MEDICAL CLINIC PC

Provider Business Mailing Address
First Line	:	16238 W WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-3701
Country	:	US
Telephone Number	:	313-438-0198
Fax Number	:	313-438-0157

Provider Business Practice Location Address
First Line	:	16238 W WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-3701
Country	:	US
Telephone Number	:	313-438-0198
Fax Number	:	313-438-0157

Authorized Official
Title or Position	:	OWNER
Name	:	ANWAR EL-KHATIB
Credential	:	PA
Telephone Number	:	313-438-0198

Provider Enumeration Date	:	11/17/2019
Last Update Date	:	11/18/2019

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Directions to “WEST PARK MEDICAL CLINIC PC ” Practice Location

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