Provider Demographics
NPI:1588850424
Name:METRO URGENT CARE
Entity type:Organization
Organization Name:METRO URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:O
Authorized Official - Last Name:ULINFUN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-388-1400
Mailing Address - Street 1:752 SOUTHFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146
Mailing Address - Country:US
Mailing Address - Phone:313-388-1400
Mailing Address - Fax:313-388-2366
Practice Address - Street 1:752 SOUTHFIELD ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146
Practice Address - Country:US
Practice Address - Phone:313-388-1400
Practice Address - Fax:313-388-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITU010840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM93840Medicare PIN
MIF42243Medicare UPIN