Provider Demographics
NPI:1578513206
Name:MILAN URGENT CARE CLINIC PLLC
Entity Type:Organization
Organization Name:MILAN URGENT CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN-CROMWELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-439-2388
Mailing Address - Street 1:3 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1248
Mailing Address - Country:US
Mailing Address - Phone:734-439-2388
Mailing Address - Fax:734-439-1384
Practice Address - Street 1:3 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1248
Practice Address - Country:US
Practice Address - Phone:734-439-2388
Practice Address - Fax:734-439-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIID076711207Q00000X
MIJB024426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0805810592OtherDR. BERSALONA BCBSM
MI0805810602OtherDR. DIAZ BCBSM
MI0805810602OtherDR. DIAZ BCBSM
MIH91283Medicare UPIN