Healthcare Provider Details

I. General information

NPI: 1558614289
Provider Name (Legal Business Name): THE WELLNESS PLAN MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21040 GREENFIELD RD
OAK PARK MI
48237-3025
US

IV. Provider business mailing address

7700 2ND AVE
DETROIT MI
48202-2477
US

V. Phone/Fax

Practice location:
  • Phone: 248-967-6500
  • Fax: 248-967-6528
Mailing address:
  • Phone: 313-202-8660
  • Fax: 313-202-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301086416
License Number StateMI

VIII. Authorized Official

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