Provider Demographics
NPI:1487880555
Name:NORTHEAST MACOMB URGENT CARE PLLC
Entity type:Organization
Organization Name:NORTHEAST MACOMB URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:IFTIKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-402-2000
Mailing Address - Street 1:33405 W. 12 MILE ROAD
Mailing Address - Street 2:STE #173 URGENT CARE MANAGEMENT
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331
Mailing Address - Country:US
Mailing Address - Phone:734-402-2000
Mailing Address - Fax:734-402-2400
Practice Address - Street 1:43900 GARFIELD ROAD
Practice Address - Street 2:STE #121 NORTHEAST MACOMB URGENT CARE PLLC
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1137
Practice Address - Country:US
Practice Address - Phone:734-402-2000
Practice Address - Fax:734-402-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7301063833261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care