Healthcare Provider Details

I. General information

NPI: 1881002491
Provider Name (Legal Business Name): EMMAUS HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRANK LLOYD WRIGHT DR L2200
ANN ARBOR MI
48105-9484
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR L2200
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-930-4020
  • Fax: 734-930-4055
Mailing address:
  • Phone: 734-930-4020
  • Fax: 734-930-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4301060012
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY KENDALL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 734-930-4020