NPIMap

Warren Urgent Care PC

Organization Active NPI Family Medicine Physician · Warren, MI

NPI 1972503902 · NPPES record last updated Oct 17, 2023

Key facts

NPI
1972503902
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
License
4301065784 (MI)
Legal business name
WARREN URGENT CARE PC
Practice address
31700 Van Dyke Ave
Warren, MI 48093-7949
Phone
(586) 276-8200
Fax
(586) 276-8181
NPI assigned
Aug 1, 2005
Organization subpart
No

Authorized official

Name
Dr. Farah Iftikhar, MD NPI 1376542035
Title
Owner/Physician
Phone
(586) 276-8200

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 21

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050616001137 MI Part B Supplier - Clinic/Group Practice 5496799751 Receives reassigned benefits from 21 practitioners
Practice locations: Warren, MI

National Provider Directory

Locations

31700 Van Dyke Ave
Warren, MI 48093
Phone (586) 276-8130

L4372
Columbus, OH 43260

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 4301065784 MI Yes
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X 4301065784 MI
Urgent Care Clinic/Center 261QU0200X 4301065784 MI

Addresses

Primary practice location

31700 Van Dyke Ave
Warren, MI 48093-7949

Mailing address

L-4372
Columbus, OH 43260-0001
Phone (586) 276-8200

Other identifiers

IdentifierTypeStateIssuer
4936010MedicaidMI
4725187MedicaidMI
700E019030OtherMIBCN
4935809MedicaidMI
4722882MedicaidMI
110E017250OtherMIBCBS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 17, 2023.

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1972503902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "L-4372",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432600001",
            "telephone_number": "586-276-8200",
            "fax_number": "586-276-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31700 VAN DYKE AVE",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937949",
            "telephone_number": "586-276-8200",
            "fax_number": "586-276-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARREN URGENT CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-01",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "IFTIKHAR",
        "authorized_official_first_name": "FARAH",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "586-276-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301065784",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301065784",
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "MI",
            "license": "4301065784",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4936010",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4725187",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "700E019030",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4935809",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4722882",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "110E017250",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

All providers in Warren, MI · Family Medicine Physician in Michigan

Sources for this page

Verify at the official NPI Registry.