Provider Demographics
NPI:1558663666
Name:NOVI URGENT CARE, PLLC
Entity type:Organization
Organization Name:NOVI URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:NASRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-946-4500
Mailing Address - Street 1:43535 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1108
Mailing Address - Country:US
Mailing Address - Phone:248-946-4500
Mailing Address - Fax:248-946-4503
Practice Address - Street 1:43535 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1108
Practice Address - Country:US
Practice Address - Phone:248-946-4500
Practice Address - Fax:248-946-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052864261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32530Medicare PIN