Provider Demographics
NPI:1881087351
Name:DELTA PRIMARY & URGENT CARE PLLC
Entity type:Organization
Organization Name:DELTA PRIMARY & URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOTAHAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-227-8072
Mailing Address - Street 1:27122 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3537
Mailing Address - Country:US
Mailing Address - Phone:248-227-8072
Mailing Address - Fax:313-871-1914
Practice Address - Street 1:27122 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3537
Practice Address - Country:US
Practice Address - Phone:248-227-8072
Practice Address - Fax:313-871-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6605001Medicare PIN
MI1982625794Medicare UPIN
MI1104931385Medicare UPIN