Healthcare Provider Details

I. General information

NPI: 1366307894
Provider Name (Legal Business Name): PROSPER HEALTH MEDICAL PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 W JEFFERSON AVE
RIVER ROUGE MI
48218-1338
US

IV. Provider business mailing address

10474 W JEFFERSON AVE
RIVER ROUGE MI
48218-1338
US

V. Phone/Fax

Practice location:
  • Phone: 727-497-7354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IGOR VOLOSHENUK
Title or Position: OWNER OPERATOR
Credential:
Phone: 929-451-8008