Basic Information
| Provider Information | |||||||||
| NPI: | 1649721499 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GREAT LAKES URGENT CARE CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1397 S LINDEN RD STE C | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485324194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107209300 | ||||||||
| FaxNumber: | 8107209304 | ||||||||
| Practice Location | |||||||||
| Address1: | 1397 S LINDEN RD STE C | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485324194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107209300 | ||||||||
| FaxNumber: | 8107209304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2016 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | SAHOURI | ||||||||
| AuthorizedOfficialFirstName: | SAED | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 8107209300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 4301056025 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.