Provider Demographics
NPI:1538497250
Name:VAN BUREN URGENT CARE CENTER PLLC
Entity Type:Organization
Organization Name:VAN BUREN URGENT CARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:HURAIBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-515-0024
Mailing Address - Street 1:11650 BELLEVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111
Mailing Address - Country:US
Mailing Address - Phone:734-699-9888
Mailing Address - Fax:734-293-1774
Practice Address - Street 1:11650 BELLEVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111
Practice Address - Country:US
Practice Address - Phone:734-699-9888
Practice Address - Fax:734-293-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI182933OtherGREAT LAKES
MI1538497250Medicaid
MI080H258740OtherBCBS GROUP
MIDQ6601OtherRAILROAD MEDICARE
MIDQ6601OtherRAILROAD MEDICARE