Healthcare Provider Details

I. General information

NPI: 1669632816
Provider Name (Legal Business Name): THE WELLNESS PLAN MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 E OUTER DR
DETROIT MI
48234-3446
US

IV. Provider business mailing address

7700 2ND AVE
DETROIT MI
48202-2411
US

V. Phone/Fax

Practice location:
  • Phone: 313-366-2000
  • Fax: 313-369-3950
Mailing address:
  • Phone: 313-202-8785
  • Fax: 313-202-6870

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 & EXECUTIVE DIRECTOR
Credential:
Phone: 313-202-8550