Provider Demographics
NPI:1972852705
Name:ELITE URGENT CARE PLLC
Entity Type:Organization
Organization Name:ELITE URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:313-736-5004
Mailing Address - Street 1:5293 HARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3309
Mailing Address - Country:US
Mailing Address - Phone:313-736-5004
Mailing Address - Fax:
Practice Address - Street 1:15301 TIREMAN AVE
Practice Address - Street 2:STE-A
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1045
Practice Address - Country:US
Practice Address - Phone:313-736-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty