MEDICARE: MICHIGAN GREENFEILD URGENT CARE CENTER

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		MI

General Provider Information

NPI Number	:	1669876025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN GREENFEILD URGENT CARE CENTER

Provider Business Mailing Address
First Line	:	24355 FORD RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1129
Country	:	US
Telephone Number	:	313-563-7777
Fax Number	:	313-908-2301

Provider Business Practice Location Address
First Line	:	24355 FORD RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1129
Country	:	US
Telephone Number	:	313-563-7777
Fax Number	:	313-908-2301

Authorized Official
Title or Position	:	CEO
Name	:	ALI EL-KHALIL
Credential	:	M.D
Telephone Number	:	313-563-7777

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	10/14/2014

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