Provider Demographics
NPI:1831838473
Name:LIFETIME MD URGENT CARE PLLC
Entity type:Organization
Organization Name:LIFETIME MD URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:DWAIK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-998-6300
Mailing Address - Street 1:1022 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1622
Mailing Address - Country:US
Mailing Address - Phone:313-998-6300
Mailing Address - Fax:
Practice Address - Street 1:1022 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1622
Practice Address - Country:US
Practice Address - Phone:313-998-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care