| Mi Express Primary Care | |
|
44237 Michigan Ave Canton MI 48188-2866 | |
| (734) 333-9001 | |
| Not Available |
| Full Name | Mi Express Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 44237 Michigan Ave, Canton, Michigan |
| Authorized Official Name and Position | Umayr Azimi (OWNER) |
| Authorized Official Contact | 7342767790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mi Express Primary Care 44237 Michigan Ave Ste B Canton MI 48188-2866 Ph: (734) 333-9001 | Mi Express Primary Care 44237 Michigan Ave Canton MI 48188-2866 Ph: (734) 333-9001 |
| NPI Number | 1609433549 |
|---|---|
| Provider Enumeration Date | 05/27/2019 |
| Last Update Date | 08/02/2023 |
| Certification Date | 08/02/2023 |
| Medicare PECOS PAC ID | 9931537495 |
|---|---|
| Medicare Enrollment ID | O20200316001164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609433549 | NPI | - | NPPES |
| 1083054902 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Jessica Lytle |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1730338807 PECOS PAC ID: 9133277668 Enrollment ID: I20090511000294 |
| Provider Name | Reina B Pearson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457754533 PECOS PAC ID: 8123341195 Enrollment ID: I20141223001627 |
| Provider Name | Umayr Ahmad Azimi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083054902 PECOS PAC ID: 1153550215 Enrollment ID: I20160715000914 |
| Provider Name | Elizabeta Zlojutro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346889185 PECOS PAC ID: 4981033776 Enrollment ID: I20200330002490 |
| Provider Name | Lyla Makled |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487338166 PECOS PAC ID: 7810357043 Enrollment ID: I20230719001125 |
| Provider Name | Abigayle Monson Ellison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528710464 PECOS PAC ID: 9335594415 Enrollment ID: I20231010000707 |
| Provider Name | Judd Koujane |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629782347 PECOS PAC ID: 4789025966 Enrollment ID: I20240520000491 |
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