Provider Demographics
NPI:1295987626
Name:MANOR URGENT CARE, PC
Entity type:Organization
Organization Name:MANOR URGENT CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:AJROUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-244-2589
Mailing Address - Street 1:10645 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-8009
Mailing Address - Country:US
Mailing Address - Phone:313-945-9393
Mailing Address - Fax:313-945-9122
Practice Address - Street 1:10645 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-8009
Practice Address - Country:US
Practice Address - Phone:313-945-9393
Practice Address - Fax:313-945-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083964261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care