Basic Information
Provider Information
NPI: 1033442355
EntityType: 2
ReplacementNPI:  
OrganizationName: GROSSE POINTE URGENT CARE PC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20311 MACK AVE
Address2:  
City: GROSSE POINTE WOODS
State: MI
PostalCode: 482361784
CountryCode: US
TelephoneNumber: 7343388300
FaxNumber: 7343388301
Practice Location
Address1: 20311 MACK AVE
Address2:  
City: GROSSE POINTE WOODS
State: MI
PostalCode: 482361784
CountryCode: US
TelephoneNumber: 7343388300
FaxNumber: 7343388301
Other Information
ProviderEnumerationDate: 09/18/2009
LastUpdateDate: 11/21/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ARSIWALA
AuthorizedOfficialFirstName: MOHAMMED
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: OWNER MEDICAL DIRECTOR PHYSICIAN
AuthorizedOfficialTelephone: 7343388300
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X4301065784MIY Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

ID Information
IDTypeStateIssuerDescription
103344235501MIBCN GROUPOTHER
740H26005001MIBC TRAD UC NETWORKOTHER


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