Provider Demographics
NPI:1386064129
Name:PRIMARY MEDICAL URGENT CARE P.C.
Entity type:Organization
Organization Name:PRIMARY MEDICAL URGENT CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRYCJA
Authorized Official - Middle Name:IZABELLA
Authorized Official - Last Name:CZESNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-629-6440
Mailing Address - Street 1:24503 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1141
Mailing Address - Country:US
Mailing Address - Phone:248-629-6440
Mailing Address - Fax:248-629-6445
Practice Address - Street 1:24503 JOHN R RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1141
Practice Address - Country:US
Practice Address - Phone:248-629-6440
Practice Address - Fax:248-629-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-20
Last Update Date:2014-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084438261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care