Organization Name: | DR WALA MEDICAL CLINIC PLC |
NPI Number: | 1548607039 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MOHAMMED AMJAD RANGINWALA (OWNER) |
Mailing Address: | 106 S Lowe St Dowagiac |
State: | MI US |
Postal Code: | 490471624 |
Phone Number: | 5743359177 |
Fax Number: | |
NPI Enumeration Date: | 05/24/2013 |
NPI Last Update Date: | 05/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 4301088022 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |