Healthcare Provider Details

I. General information

NPI: 1457975328
Provider Name (Legal Business Name): ARMADA WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23107 E MAIN ST
ARMADA MI
48005-4706
US

IV. Provider business mailing address

PO BOX 479
ARMADA MI
48005-0479
US

V. Phone/Fax

Practice location:
  • Phone: 586-784-9127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ZEINTH KHAN
Title or Position: OWNER
Credential:
Phone: 586-784-9127