Provider Demographics
NPI:1013149616
Name:QANDIL FAMILY MEDICAL & URGENT CARE CENTER PLLC
Entity Type:Organization
Organization Name:QANDIL FAMILY MEDICAL & URGENT CARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:
Authorized Official - Last Name:QANDIL
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:313-871-8900
Mailing Address - Street 1:9222 JOSEPH CAMPAU ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-4059
Mailing Address - Country:US
Mailing Address - Phone:313-871-8900
Mailing Address - Fax:313-871-8901
Practice Address - Street 1:9222 JOSEPH CAMPAU ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-4059
Practice Address - Country:US
Practice Address - Phone:313-871-8900
Practice Address - Fax:313-871-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087756261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080H256400OtherBCBS GROUP
MIDQ3273OtherRAILROAD MEDICARE
MI1013149616Medicaid
MI1013149616Medicaid