Provider Demographics
NPI:1669876025
Name:MICHIGAN GREENFEILD URGENT CARE CENTER
Entity type:Organization
Organization Name:MICHIGAN GREENFEILD URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-563-7777
Mailing Address - Street 1:24355 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1129
Mailing Address - Country:US
Mailing Address - Phone:313-563-7777
Mailing Address - Fax:313-908-2301
Practice Address - Street 1:24355 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1129
Practice Address - Country:US
Practice Address - Phone:313-563-7777
Practice Address - Fax:313-908-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2482Medicare PIN