Healthcare Provider Details

I. General information

NPI: 1306161369
Provider Name (Legal Business Name): TRIFECTA CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 N MONROE ST SUITE B-2
MONROE MI
48162-5353
US

IV. Provider business mailing address

2059 N MONROE ST SUITE B-2
MONROE MI
48162-5353
US

V. Phone/Fax

Practice location:
  • Phone: 734-244-4383
  • Fax: 734-244-4384
Mailing address:
  • Phone: 734-244-4383
  • Fax: 734-244-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2301009657
License Number StateMI

VIII. Authorized Official

Name: DR. SEAN MICHAEL TOTTEN
Title or Position: OFFICER
Credential: D.C.
Phone: 734-244-4383