Healthcare Provider Details

I. General information

NPI: 1427416783
Provider Name (Legal Business Name): THE WELLNESS PLAN MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 E OUTER DR
DETROIT MI
48234-3446
US

IV. Provider business mailing address

4909 E OUTER DR
DETROIT MI
48234-3446
US

V. Phone/Fax

Practice location:
  • Phone: 313-366-2000
  • Fax: 313-369-3952
Mailing address:
  • Phone: 313-202-8660
  • Fax: 313-202-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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