MEDICARE: URGENT CARE ONE, 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	4301052864	MI

General Provider Information

NPI Number	:	1982856167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT CARE ONE, PLLC

Provider Business Mailing Address
First Line	:	6200 MIDDLEBELT RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2409
Country	:	US
Telephone Number	:	734-367-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 MIDDLEBELT RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2409
Country	:	US
Telephone Number	:	734-367-9100
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	SAMER NASRY
Credential	:
Telephone Number	:	734-367-9100

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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