Provider Demographics
NPI:1932316643
Name:GROSSE ILE URGENT CARE PC
Entity Type:Organization
Organization Name:GROSSE ILE URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARSIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-365-5200
Mailing Address - Street 1:PO BOX 32588 05
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-0588
Mailing Address - Country:US
Mailing Address - Phone:734-365-5200
Mailing Address - Fax:734-365-5201
Practice Address - Street 1:8944 MACOMB ST
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-2089
Practice Address - Country:US
Practice Address - Phone:734-365-5200
Practice Address - Fax:734-365-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065784207Q00000X, 207R00000X
MI4301075100261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H203090OtherBLUE CARE NETWORK
MI5198757Medicaid
MI5198748Medicaid
MI700H203090OtherBLUE CROSS BLUE SHIELD
MI5198757Medicaid