Healthcare Provider Details

I. General information

NPI: 1295031441
Provider Name (Legal Business Name): THE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 PACKARD ST
ANN ARBOR MI
48104-6806
US

IV. Provider business mailing address

2515 PACKARD ST
ANN ARBOR MI
48104-6806
US

V. Phone/Fax

Practice location:
  • Phone: 248-335-7857
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCIS NWANKWO
Title or Position: OWNER
Credential:
Phone: 248-335-7857