Provider Demographics
NPI:1740450303
Name:METRO URGENT CARE & FAMILY MEDICAL CENTER PC
Entity type:Organization
Organization Name:METRO URGENT CARE & FAMILY MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:OSAYI
Authorized Official - Last Name:ULINFUN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-388-1400
Mailing Address - Street 1:752 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2610
Mailing Address - Country:US
Mailing Address - Phone:313-388-1400
Mailing Address - Fax:313-388-2366
Practice Address - Street 1:752 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2610
Practice Address - Country:US
Practice Address - Phone:313-388-1400
Practice Address - Fax:313-388-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101 010840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4167809Medicaid
MI0858206604OtherBCBSM
MI4167809Medicaid
MI0M93840Medicare PIN