Healthcare Provider Details

I. General information

NPI: 1518461524
Provider Name (Legal Business Name): PARTNERS IN WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19750 BURT RD
DETROIT MI
48219-2078
US

IV. Provider business mailing address

3031 W GRAND BLVD STE 450
DETROIT MI
48202-3026
US

V. Phone/Fax

Practice location:
  • Phone: 313-346-5235
  • Fax:
Mailing address:
  • Phone: 313-346-5235
  • Fax: 313-879-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANETTE DAVIS
Title or Position: CFO
Credential:
Phone: 313-871-3751