Provider Demographics
NPI:1477991545
Name:HAZEL PARK URGENT CARE PLLC
Entity Type:Organization
Organization Name:HAZEL PARK URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAWAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-268-2566
Mailing Address - Street 1:624 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1842
Mailing Address - Country:US
Mailing Address - Phone:248-268-2566
Mailing Address - Fax:248-268-2560
Practice Address - Street 1:624 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1842
Practice Address - Country:US
Practice Address - Phone:248-268-2566
Practice Address - Fax:248-268-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
4301076703261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center