Provider Demographics
NPI:1104045384
Name:EPG URGENT CARE PLLC
Entity type:Organization
Organization Name:EPG URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-544-6236
Mailing Address - Street 1:911 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1934
Mailing Address - Country:US
Mailing Address - Phone:248-545-7210
Mailing Address - Fax:248-545-3058
Practice Address - Street 1:26454 WOODWARD AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0969
Practice Address - Country:US
Practice Address - Phone:248-545-7210
Practice Address - Fax:248-545-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
024655OtherMIDWEST FACILITY #
MI110405384Medicaid
MI00002662456OtherUNITED HEALTH CARE FACILITY #
MI110F346760OtherBCBS GROUP
MI110405384Medicaid