Provider Demographics
NPI:1083845804
Name:MIDWEST URGENT CARE CENTER PC
Entity Type:Organization
Organization Name:MIDWEST URGENT CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:VLACHOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-592-6330
Mailing Address - Street 1:PO BOX 3054
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-3054
Mailing Address - Country:US
Mailing Address - Phone:313-592-6330
Mailing Address - Fax:313-592-6331
Practice Address - Street 1:15540 BEECH DALY RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3804
Practice Address - Country:US
Practice Address - Phone:313-592-6330
Practice Address - Fax:313-592-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care