Provider Demographics
NPI:1285058404
Name:UNIVERSAL CLINIC AND URGENT CARE PC
Entity type:Organization
Organization Name:UNIVERSAL CLINIC AND URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:NAVEED
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-432-2656
Mailing Address - Street 1:4600 E 14 MILE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4369
Mailing Address - Country:US
Mailing Address - Phone:248-432-2656
Mailing Address - Fax:
Practice Address - Street 1:4600 E 14 MILE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4369
Practice Address - Country:US
Practice Address - Phone:248-432-2656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty