Healthcare Provider Details

I. General information

NPI: 1235651381
Provider Name (Legal Business Name): THE WELLNESS PLAN MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46156 WOODWARD AVE
PONTIAC MI
48342-5033
US

IV. Provider business mailing address

7700 2ND AVE
DETROIT MI
48202-2477
US

V. Phone/Fax

Practice location:
  • Phone: 248-897-0900
  • Fax: 248-858-6499
Mailing address:
  • Phone: 313-202-8660
  • Fax: 313-202-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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