Provider Demographics
NPI:1295017085
Name:UTICA SHELBY URGENT CARE PC
Entity Type:Organization
Organization Name:UTICA SHELBY URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUNJESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-258-8791
Mailing Address - Street 1:45569 VAN DYKE AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5617
Mailing Address - Country:US
Mailing Address - Phone:586-258-8791
Mailing Address - Fax:
Practice Address - Street 1:45569 VAN DYKE AVE
Practice Address - Street 2:STE 3
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5617
Practice Address - Country:US
Practice Address - Phone:586-258-8791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090856261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care