Provider Demographics
NPI:1689259723
Name:UNITED MEDICAL DEVELOPMENT LLC
Entity Type:Organization
Organization Name:UNITED MEDICAL DEVELOPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANZOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:JALLOUQA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-972-8535
Mailing Address - Street 1:29155 NORTHWESTERN HWY STE 366
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1011
Mailing Address - Country:US
Mailing Address - Phone:312-972-8535
Mailing Address - Fax:
Practice Address - Street 1:29155 NORTHWESTERN HWY STE 366
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1011
Practice Address - Country:US
Practice Address - Phone:312-972-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy