Healthcare Provider Details

I. General information

NPI: 1114420353
Provider Name (Legal Business Name): THE WELLNESS PLAN MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27321 HAMPDEN ST RM 202
MADISON HEIGHTS MI
48071-3113
US

IV. Provider business mailing address

7700 2ND AVE
DETROIT MI
48202-2411
US

V. Phone/Fax

Practice location:
  • Phone: 313-202-8660
  • Fax:
Mailing address:
  • Phone: 313-202-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SHERRI ATWATER
Title or Position: COMPLIANCE AND CREDENTIALING
Credential:
Phone: 313-202-8500