Provider Demographics
NPI:1053516617
Name:LINCOLN PARK URGENT CARE P.C.
Entity type:Organization
Organization Name:LINCOLN PARK URGENT CARE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELL-FATTAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-383-3333
Mailing Address - Street 1:15101 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2697
Mailing Address - Country:US
Mailing Address - Phone:313-383-3333
Mailing Address - Fax:313-383-5555
Practice Address - Street 1:15101 SOUTHFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2697
Practice Address - Country:US
Practice Address - Phone:313-383-3333
Practice Address - Fax:313-383-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012667207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N53370Medicare PIN