Provider Demographics
NPI:1326420811
Name:MERIT HEALTH CARE CLINIC, PLLC
Entity Type:Organization
Organization Name:MERIT HEALTH CARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:M-E
Authorized Official - Last Name:MUKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-652-6333
Mailing Address - Street 1:3390 N STATE RD STE A
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1154
Mailing Address - Country:US
Mailing Address - Phone:810-652-6333
Mailing Address - Fax:
Practice Address - Street 1:3390 N STATE RD STE A
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1154
Practice Address - Country:US
Practice Address - Phone:810-652-6333
Practice Address - Fax:810-652-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08788367Medicaid