Provider Demographics
NPI:1649755125
Name:EXPRESS MED URGENT CARE, PLLC
Entity Type:Organization
Organization Name:EXPRESS MED URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:KATTOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-678-5117
Mailing Address - Street 1:4016 PARKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3967
Mailing Address - Country:US
Mailing Address - Phone:248-678-5117
Mailing Address - Fax:248-658-8777
Practice Address - Street 1:19725 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2584
Practice Address - Country:US
Practice Address - Phone:248-678-5117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care