Provider Demographics
NPI:1477978930
Name:GREAT LAKES URGENT CARE PC OF EASTSIDE
Entity Type:Organization
Organization Name:GREAT LAKES URGENT CARE PC OF EASTSIDE
Other - Org Name:GLUCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FUAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAHIMEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-773-1383
Mailing Address - Street 1:19070 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1449
Mailing Address - Country:US
Mailing Address - Phone:586-773-1383
Mailing Address - Fax:586-773-1385
Practice Address - Street 1:19070 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1449
Practice Address - Country:US
Practice Address - Phone:586-773-1383
Practice Address - Fax:586-773-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101093161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty