Basic Information
| Provider Information | |||||||||
| NPI: | 1497225403 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHIGAN FAMILY MEDICINE AND URGENT CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 43 | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488540043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176046177 | ||||||||
| FaxNumber: | 5176046184 | ||||||||
| Practice Location | |||||||||
| Address1: | 13811 MYRTLE DR | ||||||||
| Address2: | |||||||||
| City: | DEWITT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488208509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894002889 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2018 | ||||||||
| LastUpdateDate: | 12/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | SALMAN RAIS | ||||||||
| AuthorizedOfficialFirstName: | MUHAMMAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9894002889 | ||||||||
| 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 | 208D00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.