Provider Demographics
NPI:1164756417
Name:UNITED FAMILY CARE
Entity Type:Organization
Organization Name:UNITED FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRITOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-604-8108
Mailing Address - Street 1:454 E SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1265
Mailing Address - Country:US
Mailing Address - Phone:586-604-8108
Mailing Address - Fax:
Practice Address - Street 1:12170 CONANT ST
Practice Address - Street 2:SUITE C-2
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-4137
Practice Address - Country:US
Practice Address - Phone:313-366-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079852261QE0002X, 261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0950444OtherBLUE SHIELD
MI491643810Medicaid
MIMI1934Medicare PIN