Healthcare Provider Details

I. General information

NPI: 1447675434
Provider Name (Legal Business Name): THE WELLNESS PLAN MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE SUITE H-13
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

7700 2ND AVE
DETROIT MI
48202-2411
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-3126
  • Fax: 248-858-6499
Mailing address:
  • Phone: 313-202-8660
  • Fax: 313-202-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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