Provider Demographics
NPI:1548607039
Name:DR WALA MEDICAL CLINIC PLC
Entity Type:Organization
Organization Name:DR WALA MEDICAL CLINIC PLC
Other - Org Name:DR WALA CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:AMJAD
Authorized Official - Last Name:RANGINWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-335-9177
Mailing Address - Street 1:14360 WYNSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4202
Mailing Address - Country:US
Mailing Address - Phone:574-335-9177
Mailing Address - Fax:
Practice Address - Street 1:106 S LOWE ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1624
Practice Address - Country:US
Practice Address - Phone:574-335-9177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088022261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care