Provider Demographics
NPI:1194251314
Name:MY URGENT MEDICAL MANAGEMENT SERVICES
Entity type:Organization
Organization Name:MY URGENT MEDICAL MANAGEMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KETELHUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-820-9828
Mailing Address - Street 1:2232 S MAIN ST
Mailing Address - Street 2:SUITE 475
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6938
Mailing Address - Country:US
Mailing Address - Phone:248-820-9828
Mailing Address - Fax:734-692-1911
Practice Address - Street 1:21090 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-1602
Practice Address - Country:US
Practice Address - Phone:248-820-9828
Practice Address - Fax:734-926-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center