Provider Demographics
NPI:1124788666
Name:WEST DEARBORN URGENT CARE PLLC
Entity type:Organization
Organization Name:WEST DEARBORN URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GHATTAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-481-1945
Mailing Address - Street 1:2421 MONROE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3043
Mailing Address - Country:US
Mailing Address - Phone:313-447-0888
Mailing Address - Fax:313-458-4004
Practice Address - Street 1:2421 MONROE ST STE 102
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3043
Practice Address - Country:US
Practice Address - Phone:313-447-0888
Practice Address - Fax:313-458-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-25
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty