Basic Information
| Provider Information | |||||||||
| NPI: | 1194131581 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FERNDALE URGENT CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 641 W 9 MILE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FERNDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482201779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343388300 | ||||||||
| FaxNumber: | 7343388301 | ||||||||
| Practice Location | |||||||||
| Address1: | 641 W 9 MILE RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FERNDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482201779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343388300 | ||||||||
| FaxNumber: | 7343388301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2014 | ||||||||
| LastUpdateDate: | 07/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | ARSIWALA | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7343388300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 | 1750380408 | 05 | MI | MEDICAID |