Provider Demographics
NPI:1194131581
Name:FERNDALE URGENT CARE
Entity type:Organization
Organization Name:FERNDALE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-338-8300
Mailing Address - Street 1:641 W 9 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1779
Mailing Address - Country:US
Mailing Address - Phone:734-338-8300
Mailing Address - Fax:734-338-8301
Practice Address - Street 1:641 W 9 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1779
Practice Address - Country:US
Practice Address - Phone:734-338-8300
Practice Address - Fax:734-338-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065784261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1750380408Medicaid