Basic Information
| Provider Information | |||||||||
| NPI: | 1194161489 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONNER CREEK URGENT CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4777 E OUTER DR | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482343241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133699100 | ||||||||
| FaxNumber: | 3133695688 | ||||||||
| Practice Location | |||||||||
| Address1: | 4777 E OUTER DR | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482343241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133699100 | ||||||||
| FaxNumber: | 3133695688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 05/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | ARSIWALA | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER MEDICAL DIRECTOR PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7343388300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.