Basic Information
| Provider Information | |||||||||
| NPI: | 1861866980 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CITY URGENT CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 N CAMPBELL RD | ||||||||
| Address2: | STE 3 | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480671570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043884712 | ||||||||
| FaxNumber: | 9043882138 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 N CAMPBELL RD | ||||||||
| Address2: | STE 3 | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480671570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043884712 | ||||||||
| FaxNumber: | 9043882138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2015 | ||||||||
| LastUpdateDate: | 12/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | SHAYA | ||||||||
| AuthorizedOfficialFirstName: | WISSAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9043884712 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.