Healthcare Provider Details

I. General information

NPI: 1699949479
Provider Name (Legal Business Name): DR. WENDY MCKAY P.C. DBA SPRINGWELLS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 SPRINGWELLS ST
DETROIT MI
48209-1507
US

IV. Provider business mailing address

2117 SPRINGWELLS ST
DETROIT MI
48209-1507
US

V. Phone/Fax

Practice location:
  • Phone: 313-842-1800
  • Fax: 313-842-0600
Mailing address:
  • Phone: 313-842-1800
  • Fax: 313-842-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number4301045701
License Number StateMI

VIII. Authorized Official

Name: DR. WENDY YOUSIF MCKAY
Title or Position: OWNER
Credential: M.D.
Phone: 313-842-8300