Provider Demographics
NPI:1114107331
Name:ASPEN URGENT CARE
Entity Type:Organization
Organization Name:ASPEN URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-215-4109
Mailing Address - Street 1:5501 MCLAIN DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2513
Mailing Address - Country:US
Mailing Address - Phone:419-882-5937
Mailing Address - Fax:
Practice Address - Street 1:7581 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9624
Practice Address - Country:US
Practice Address - Phone:734-856-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088893302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization