| Organization Name: | GREAT LAKES URGENT CARE PC OF EASTSIDE |
| NPI Number: | 1144645284 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FUAD M RAHIMEE (MEDICAL DIRECTOR) |
| Mailing Address: | 19070 E 10 Mile Rd Eastpointe |
| State: | MI US |
| Postal Code: | 480211449 |
| Phone Number: | 5867731383 |
| Fax Number: | 5867731385 |
| NPI Enumeration Date: | 02/26/2014 |
| NPI Last Update Date: | 03/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |