Healthcare Provider Details

I. General information

NPI: 1780312397
Provider Name (Legal Business Name): THE WELLNESS PLAN MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/10/2022
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:
Mailing address:
  • Phone: 313-202-8660
  • Fax: 313-202-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BETTY SHELTON
Title or Position: CHIEF ADMINISTRATION OFFICER
Credential:
Phone: 313-202-8660