Basic Information
| Provider Information | |||||||||
| NPI: | 1841472446 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUNDEE URGENT CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32588 09 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482320588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348239500 | ||||||||
| FaxNumber: | 7348235425 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 POWELL DR | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | DUNDEE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481318644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348235900 | ||||||||
| FaxNumber: | 7348235425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | ARSIWALA | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMAD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7348235900 | ||||||||
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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 | 207Q00000X | 4301065784 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QU0200X | 4301065784 | MI | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 207R00000X | 4301065784 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 227034 | 01 | MI | DEPT OF LABOR MI | OTHER | 18272 | 01 | MI | HEALTH PLAN OF MI | OTHER | P00610343 | 01 | MI | RAILROAD MEDICARE | OTHER | 04965 | 01 | MI | PARAMOUNT | OTHER | 612434400 | 01 | MI | DEPT OF LABOR FED | OTHER | 700E811670 | 01 | MI | BCN GROUP | OTHER | 165987 | 01 | MI | GREAT LAKES | OTHER | 110E811580 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 1841472446 | 05 | MI | MEDICAID | DN2395 | 01 | MI | RAILROAD MEDICARE GROUP | OTHER | 025449 | 01 | MI | MIDWEST HEALTH PLAN | OTHER | 524933710 | 05 | MI | MEDICAID | 82027100 | 01 | MI | PROCARE | OTHER |