Provider Demographics
NPI:1114656576
Name:PIONEER MEDICAL AND URGENT CARE PLLC
Entity Type:Organization
Organization Name:PIONEER MEDICAL AND URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EL ADBALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-330-0033
Mailing Address - Street 1:26200 FORD RD UNIT 908
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4342
Mailing Address - Country:US
Mailing Address - Phone:313-330-0033
Mailing Address - Fax:
Practice Address - Street 1:6675 ROCKDALE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4342
Practice Address - Country:US
Practice Address - Phone:313-330-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center