Provider Demographics
NPI:1619338621
Name:MAXCARE URGENT CARE PC
Entity Type:Organization
Organization Name:MAXCARE URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:I
Authorized Official - Last Name:HOMISHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-657-8400
Mailing Address - Street 1:9222 JOSEPH CAMPAU ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-4059
Mailing Address - Country:US
Mailing Address - Phone:313-657-8400
Mailing Address - Fax:
Practice Address - Street 1:9222 JOSEPH CAMPAU ST
Practice Address - Street 2:SUITE D
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-4059
Practice Address - Country:US
Practice Address - Phone:313-657-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092482261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI9691Medicare PIN