Provider Demographics
NPI:1790407716
Name:FAITH URGENT CARE PLLC
Entity Type:Organization
Organization Name:FAITH URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBCHB
Authorized Official - Phone:248-245-6533
Mailing Address - Street 1:15645 FARMINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2851
Mailing Address - Country:US
Mailing Address - Phone:734-464-7600
Mailing Address - Fax:734-464-9797
Practice Address - Street 1:15645 FARMINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2851
Practice Address - Country:US
Practice Address - Phone:734-464-7600
Practice Address - Fax:734-464-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301109743OtherSTATE LICENSE