Provider Demographics
NPI:1669707378
Name:MEADOWBROOK URGENT CARE II PC
Entity type:Organization
Organization Name:MEADOWBROOK URGENT CARE II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-476-8500
Mailing Address - Street 1:25500 MEADOWBROOK RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1878
Mailing Address - Country:US
Mailing Address - Phone:248-476-8500
Mailing Address - Fax:248-522-0041
Practice Address - Street 1:25500 MEADOWBROOK RD
Practice Address - Street 2:SUITE 190
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1878
Practice Address - Country:US
Practice Address - Phone:248-476-8500
Practice Address - Fax:248-522-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013830261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH65468OtherUPIN