Basic Information
| Provider Information | |||||||||
| NPI: | 1174874531 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHTENAW URGENT CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17197 N LAUREL PARK DR STE 107 | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481527910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343388300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3280 WASHTENAW AVE | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481044250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343892000 | ||||||||
| FaxNumber: | 7343892005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ARSIWALA | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7343388300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301047767 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QU0200X | MI | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 207R00000X | 4301065784 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1477806875 | 05 | MI | MEDICAID |