Healthcare Provider Details

I. General information

NPI: 1316997422
Provider Name (Legal Business Name): HEALTH ONE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 DIX HWY
LINCOLN PARK MI
48146-2591
US

IV. Provider business mailing address

PO BOX 339
WYANDOTTE MI
48192-0339
US

V. Phone/Fax

Practice location:
  • Phone: 313-381-5674
  • Fax: 313-381-7224
Mailing address:
  • Phone: 313-381-5674
  • Fax: 313-381-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRC066966
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberKS039208
License Number StateMI

VIII. Authorized Official

Name: CHARMAINE WARDENA
Title or Position: ADMINISTRATOR
Credential:
Phone: 313-381-5674