Provider Demographics
NPI:1194083410
Name:PROCARE URGENT CARE LLC
Entity type:Organization
Organization Name:PROCARE URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAKAIB
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAZZAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-291-2626
Mailing Address - Street 1:3727 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3182
Mailing Address - Country:US
Mailing Address - Phone:414-291-2626
Mailing Address - Fax:
Practice Address - Street 1:3727 W WISCONSIN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3182
Practice Address - Country:US
Practice Address - Phone:414-291-2626
Practice Address - Fax:414-431-0050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROCARE MEDICAL GROUP, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care