NPIMap

Organization Active NPI

Universal Clinic P.C.

  • Legal Medicine
  • Southfield, MI
National Provider Identifier
1104860212
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
Legal business name
UNIVERSAL CLINIC P.C.
Practice address
18597 W 10 Mile Rd
Ste #1
Southfield, MI 48075-2663
Phone
(248) 569-5100
Fax
(248) 569-4774
NPI assigned
Jun 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marina Ilyayev
Title
Manager
Phone
(248) 569-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193200000X MULTI-SPECIALTY GROUP 173000000X Primary

Addresses

Primary practice location

18597 W 10 Mile Rd
Ste #1
Southfield, MI 48075-2663

Mailing address

PO Box 198
Southfield, MI 48037
Phone (248) 569-5100

National Provider Directory

National Provider Directory
Tax ID family
Port Huron Clinic P C2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

18597 W 10 Mile Rd
Ste 1
Southfield, MI 48075
Phone (248) 569-5100

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104860212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48037",
            "telephone_number": "248-569-5100",
            "fax_number": "248-569-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18597 W 10 MILE RD",
            "address_2": "STE #1",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752663",
            "telephone_number": "248-569-5100",
            "fax_number": "248-569-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSAL CLINIC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ILYAYEV",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "248-569-5100"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.