Basic Information
| Provider Information | |||||||||
| NPI: | 1306179627 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GROSSE POINTE URGENT CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20311 MACK AVE | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482361784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134996000 | ||||||||
| FaxNumber: | 3134996001 | ||||||||
| Practice Location | |||||||||
| Address1: | 20311 MACK AVE | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482361784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134996000 | ||||||||
| FaxNumber: | 3134996001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2009 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | ARSIWALA | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER MEDICAL DIRECTOR PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3134996000 | ||||||||
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| 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 | 207R00000X | 4301065784 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | DQ2395 | 01 | MI | RAILROAD MEDICARE | OTHER | 700H256650 | 01 | MI | BCBS GROUP | OTHER | 1306179627 | 05 | MI | MEDICAID |