Provider Demographics
NPI:1255083366
Name:ICARE URGENT CARE PLLC
Entity type:Organization
Organization Name:ICARE URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHOROIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:FAHTME
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-623-3975
Mailing Address - Street 1:32320 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1423
Mailing Address - Country:US
Mailing Address - Phone:313-578-1911
Mailing Address - Fax:
Practice Address - Street 1:23850 VAN BORN RD STE B
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2325
Practice Address - Country:US
Practice Address - Phone:313-278-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid