Provider Demographics
NPI:1962114918
Name:MEADOWBROOK SOUTHFIELD URGENT CARE PC
Entity type:Organization
Organization Name:MEADOWBROOK SOUTHFIELD URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-940-2700
Mailing Address - Street 1:29984 TELEGRAPH RD STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1355
Mailing Address - Country:US
Mailing Address - Phone:248-940-2700
Mailing Address - Fax:248-919-4901
Practice Address - Street 1:29984 TELEGRAPH RD STE A
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1355
Practice Address - Country:US
Practice Address - Phone:248-940-2700
Practice Address - Fax:248-919-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care