Provider Demographics
NPI:1417385873
Name:CHARLOTTE FAMILY AND URGENT CARE CENTER, PC
Entity Type:Organization
Organization Name:CHARLOTTE FAMILY AND URGENT CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HALLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO, FACP, FAAP
Authorized Official - Phone:517-543-7800
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-0327
Mailing Address - Country:US
Mailing Address - Phone:517-543-7800
Mailing Address - Fax:
Practice Address - Street 1:616 MEIJER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-8376
Practice Address - Country:US
Practice Address - Phone:517-543-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012000261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP25920001Medicare PIN