Provider Demographics
NPI:1033231667
Name:WESTERN WAYNE URGENT CARE PC
Entity Type:Organization
Organization Name:WESTERN WAYNE URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARSIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-259-0500
Mailing Address - Street 1:PO BOX 32588 08
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232
Mailing Address - Country:US
Mailing Address - Phone:734-259-0500
Mailing Address - Fax:734-259-0505
Practice Address - Street 1:2050 N HAGGERTY RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3795
Practice Address - Country:US
Practice Address - Phone:734-259-0500
Practice Address - Fax:734-259-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065784207Q00000X, 207R00000X
MI4301075100261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4996537Medicaid
MI5174915Medicaid
MI4995692Medicaid
MI0220399OtherDEPT OF LABOR
MI700H230870OtherBCBS
MI4995709Medicaid
MI4995692Medicaid