Organization
LAKE HURON URGENT CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL)
(909) 235-4307
Entity
Organization
Contact information
Practice address
4190 24TH AVE, FORT GRATIOT, MI 48059-3882
(810) 216-1366
(810) 216-1526
Mailing address
PO BOX 610669, PORT HURON, MI 48061-0669
(810) 216-1366
(810) 216-1526
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/24/2016
Last updated
03/23/2017
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