Provider Demographics
NPI:1487085395
Name:VERNOR URGENT CARE PLLC
Entity type:Organization
Organization Name:VERNOR URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HURAIBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-254-9693
Mailing Address - Street 1:3456 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1551
Mailing Address - Country:US
Mailing Address - Phone:313-254-9693
Mailing Address - Fax:734-629-1567
Practice Address - Street 1:3456 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1551
Practice Address - Country:US
Practice Address - Phone:313-254-9693
Practice Address - Fax:734-629-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1487085395OtherAETNA ANCILLARY
MI700H286540OtherBC ANCILLARY PIN
MI700H286540OtherBCN ANCILLARY PIN
MI1487085395OtherMIDWEST ANCILLARY