MEDICARE: NUCH OF MICHIGAN, INC.

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	:	1801261433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUCH OF MICHIGAN, INC.

Provider Business Mailing Address
First Line	:	3035 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5039
Country	:	US
Telephone Number	:	877-654-0472
Fax Number	:	469-893-7636

Provider Business Practice Location Address
First Line	:	3035 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5039
Country	:	US
Telephone Number	:	877-654-0472
Fax Number	:	469-893-7636

Authorized Official
Title or Position	:	SVP OF OUTPATIENT SERVICES, TENET
Name	:	MR. MICHAEL KYLE BURTNETT
Credential	:
Telephone Number	:	469-893-2902

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	06/08/2016

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