Basic Information
| Provider Information | |||||||||
| NPI: | 1114109857 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DUNDEE URGENT CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32588 | ||||||||
| Address2: | 09 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482320588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348239500 | ||||||||
| FaxNumber: | 7348235425 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 POWELL DR | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | DUNDEE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481318644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348235900 | ||||||||
| FaxNumber: | 7348235425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 07/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | ARSIWALA | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7348235900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 4301065784 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 700E811670 | 01 | MI | BCN GROUP | OTHER |