MEDICARE: HEALTHY URGENT CARE

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	207Q00000X	Family Medicine Physician
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1730531914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY URGENT CARE

Provider Business Mailing Address
First Line	:	7125 ORCHARD LAKE RD STE 101
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3616
Country	:	US
Telephone Number	:	248-865-7481
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 ORCHARD LAKE RD STE 100
Second Line	:
City	:	W BLOOMFIELD
State	:	MI
Zip	:	48322-3616
Country	:	US
Telephone Number	:	248-865-7481
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	RACHEL PEREZ
Credential	:
Telephone Number	:	248-865-7481

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	02/05/2019

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