Healthcare Provider Details

I. General information

NPI: 1801148911
Provider Name (Legal Business Name): THE WELLNESS PLAN MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 W GRAND BLVD
DETROIT MI
48202-2612
US

IV. Provider business mailing address

7700 2ND AVE
DETROIT MI
48202-2477
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-4200
  • Fax: 313-875-5611
Mailing address:
  • Phone: 313-202-8660
  • Fax: 313-202-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY V. KING
Title or Position: CEO AND EXECUTIVE DIRECTOR
Credential:
Phone: 313-202-8550