Healthcare Provider Details

I. General information

NPI: 1093055857
Provider Name (Legal Business Name): ULIMATE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 GRATIOT AVE
DETROIT MI
48213-2816
US

IV. Provider business mailing address

7220 GRATIOT AVE
DETROIT MI
48213-2816
US

V. Phone/Fax

Practice location:
  • Phone: 313-579-3472
  • Fax: 313-579-1388
Mailing address:
  • Phone: 313-579-3472
  • Fax: 313-579-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEMERIUS L WARE
Title or Position: SOLE MEMBER
Credential: DC
Phone: 313-579-3472