Healthcare Provider Details

I. General information

NPI: 1366365165
Provider Name (Legal Business Name): VIBRANT LIFE MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 MONROE ST STE 101
DEARBORN MI
48124-2926
US

IV. Provider business mailing address

2021 MONROE ST STE 101
DEARBORN MI
48124-2926
US

V. Phone/Fax

Practice location:
  • Phone: 313-254-9151
  • Fax:
Mailing address:
  • Phone: 313-254-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WAFAH JAWAD KADHIM
Title or Position: PHYSICIAN
Credential: MD
Phone: 313-254-9151