Provider Demographics
NPI:1427121102
Name:MED EXPRESS OF MICH PC
Entity type:Organization
Organization Name:MED EXPRESS OF MICH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEICHAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-962-6000
Mailing Address - Street 1:PO BOX 2130
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49016-2130
Mailing Address - Country:US
Mailing Address - Phone:269-962-6000
Mailing Address - Fax:269-565-1900
Practice Address - Street 1:233 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3463
Practice Address - Country:US
Practice Address - Phone:269-962-6000
Practice Address - Fax:269-565-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4752228Medicaid
OP19850Medicare ID - Type Unspecified