Healthcare Provider Details

I. General information

NPI: 1285022442
Provider Name (Legal Business Name): BELLECARE MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OWEN ST
BELLEVILLE MI
48111-2921
US

IV. Provider business mailing address

25 OWEN ST
BELLEVILLE MI
48111-2921
US

V. Phone/Fax

Practice location:
  • Phone: 734-699-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301039079
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704265133
License Number StateMI

VIII. Authorized Official

Name: DR. THEODORE DENSLEY
Title or Position: OWNER
Credential: MD
Phone: 313-699-5400