Provider Demographics
NPI:1578868089
Name:HEALING HANDS URGENT CARE MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:HEALING HANDS URGENT CARE MEDICAL CLINIC PC
Other - Org Name:HEALING HANDS URGENT CARE MEDICAL CLINIC,PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:NURIL
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-857-7878
Mailing Address - Street 1:2157 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SYLVAN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1749
Mailing Address - Country:US
Mailing Address - Phone:248-857-7878
Mailing Address - Fax:248-932-8673
Practice Address - Street 1:2157 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320-1749
Practice Address - Country:US
Practice Address - Phone:248-857-7878
Practice Address - Fax:248-932-8673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011134207P00000X
MI4301048260208000000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1578868089Medicaid
MIMI4744Medicare PIN