MEDICARE: HEALTHY WOMEN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	5315011523	MI

General Provider Information

NPI Number	:	1992095178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY WOMEN PLLC

Provider Business Mailing Address
First Line	:	1109 W LONG LAKE RD
Second Line	:
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48302-1967
Country	:	US
Telephone Number	:	248-594-0002
Fax Number	:	248-594-6236

Provider Business Practice Location Address
First Line	:	1109 W LONG LAKE RD
Second Line	:
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48302-1967
Country	:	US
Telephone Number	:	248-594-0002
Fax Number	:	248-594-6236

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CHRISTINE T. WADE
Credential	:	M.D.
Telephone Number	:	248-872-3261

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	04/08/2011

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