Basic Information
| Provider Information | |||||||||
| NPI: | 1568760353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIGHTON URGENT CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 GENOA BUSINESS PARK DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481147367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108440400 | ||||||||
| FaxNumber: | 8108440804 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 GENOA BUSINESS PARK DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481147367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108440400 | ||||||||
| FaxNumber: | 8108440804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2011 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | ARSIWALA | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8108440400 | ||||||||
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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 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207V00000X | MI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207R00000X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1568760353 | 05 | MI | MEDICAID | DR6514 | 01 | MI | RAILROAD MEDICARE GROUP | OTHER | 700D701300 | 01 | MI | BCBS GROUP | OTHER |