Southgate Urgent Care PC
Organization Active NPI Family Medicine Physician · Southgate, MI
NPI 1902904436 · NPPES record last updated Oct 17, 2023
Key facts
- NPI
- 1902904436
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4301065784 (MI)
- Legal business name
- SOUTHGATE URGENT CARE PC
- Practice address
- 14523 Northline Rd
Southgate, MI 48195-2446 - Phone
- (734) 324-7800
- Fax
- (734) 324-7801
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Farah Iftikhar, MD
- Title
- Owner/Med Dir/Phy
- Phone
- (734) 324-7800
Practitioners 23
-
Azza Mohamed Ali, MD
-
Harry Gee, M.D.
-
Farah Iftikhar, MD
-
Kiara Nunnally, NURSE PRACTITIONER
-
Kathie Ann Pereira, MSN, FNP-BC
-
Christofer J Edwards, PA-C
-
Ali M Khan, MD
-
Connor S Mentzer, PA-C
-
Arshia Akram, MD
-
Chong U Yi, MD
-
Lori A Jacobs, FNP-C
-
Ayaz Ahamed, P.A.
-
Leila Akhavan Shahr Ashoub, MS, PA-C
-
Matthew Edwards, PA-C
-
Katilyn Hess, PA
-
Daniel Liendo, PA
-
William K Burckhard, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060315000460 | MI | Part B Supplier - Clinic/Group Practice | 0143237172 |
Receives reassigned benefits from 23 practitioners Practice locations: Southgate, MI |
National Provider Directory
Locations
14523 Northline Rd
Southgate, MI 48195
Phone (734) 324-7800
L4380
Columbus, OH 43260
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 4301065784 | MI | Yes |
| Internal Medicine Physician |
207R00000X | 4301065784 | MI | |
| Urgent Care Clinic/Center | 261QU0200X | 4301065784 | MI |
Addresses
Primary practice location
14523 Northline Rd
Southgate, MI 48195-2446
Mailing address
L-4380
Columbus, OH 43260-0001
Phone (734) 324-7800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62939 | Other | MI | OMNICARE |
| 110H227310 | Other | MI | BCBS |
| 156139 | Other | MI | GREAT LAKES |
| 700H228480 | Other | MI | BCN |
| 7810798 | Other | MI | AETNA |
| P003241979 | Other | MI | RAILROAD MEDICARE |
| P00338457 | Other | MI | RAILROAD MEDICARE |
| 064434 | Other | MI | HAP |
| NC020671 | Other | MI | MCARE |
| 029561 | Other | MI | MIDWEST |
| 142293 | Other | MI | CARE CHOICES |
| 000000014110 | Other | MI | CAPE |
| DF1019 | Other | MI | RAILROAD MEDICARE |
Other providers in Southgate, MI
- Southgate Medical Center PLLC
- Southgate Medical Clinic PC
- Southgate Medical Group, PLLC
- Southgate Mi Opco LLC
- Southgate Urgent Care PC
- Southgate X-Ray Nuclear Medicine & Ultrasound, PC
- Southland Chiropractic Center, P.C
- Erin Elizabeth Sowards
- Elizabeth Spanish-Hebert
- David Spears
All providers in Southgate, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.