Acadian Medical Provider

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

License

4301088706 Issued in MI

Legal business name

ACADIAN MEDICAL PROVIDER

Practice address

1158 Fort St
Lincoln Park, MI 48146-1840

Phone

(313) 399-4491

Fax

(248) 494-7440

NPI assigned

Sep 7, 2015

Organization subpart

No

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

Authorized official

Name

Eqdam N Rahdi, MD

Title

MD

Phone

(313) 399-4491

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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

• Eqdam N Radhi, MD

  • Internal Medicine Physician
  • Allen Park, MI
  • NPI 1710155718
  Medicare reassignment NPD

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

{
    "created_epoch": "1441584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441584000000",
    "number": "1720456866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1158 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481461840",
            "telephone_number": "313-399-4491",
            "fax_number": "248-494-7440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1158 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481461840",
            "telephone_number": "313-399-4491",
            "fax_number": "248-494-7440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADIAN MEDICAL PROVIDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-07",
        "last_updated": "2015-09-07",
        "status": "A",
        "authorized_official_last_name": "RAHDI",
        "authorized_official_first_name": "EQDAM",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "313-399-4491",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "MI",
            "license": "4301088706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4301088706",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Urgent Care Clinic/Center in Lincoln Park, MI
• Providers in Lincoln Park, MI by specialty
• Urgent Care Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.