Provider Demographics
NPI:1932108529
Name:AM URGENT CARE PLC
Entity Type:Organization
Organization Name:AM URGENT CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-893-5493
Mailing Address - Street 1:13031 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2361
Mailing Address - Country:US
Mailing Address - Phone:313-893-5493
Mailing Address - Fax:313-893-5495
Practice Address - Street 1:13031 CONANT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2361
Practice Address - Country:US
Practice Address - Phone:313-893-5493
Practice Address - Fax:313-893-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGP068359207Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10860OtherCAPE
MI4653542Medicaid
MI0H22668OtherBCN
MIG07647OtherFOUR STAR
MI024242OtherMIDWEST
MI7323066OtherAETNA
MI7620OtherHEALTH PLAN OF MI
MI700H222990OtherBCBC BCN
MI0P03100Medicare PIN