Provider Demographics
NPI:1699171884
Name:WELLNESS URGENT CARE PC
Entity type:Organization
Organization Name:WELLNESS URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-584-6690
Mailing Address - Street 1:14515 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3151
Mailing Address - Country:US
Mailing Address - Phone:313-584-6690
Mailing Address - Fax:
Practice Address - Street 1:14515 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3151
Practice Address - Country:US
Practice Address - Phone:313-584-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060838261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN