Healthcare Provider Details

I. General information

NPI: 1093647687
Provider Name (Legal Business Name): SOVEREIGN HEALTH MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUSTIN AVE
ROCHESTER HILLS MI
48309-3668
US

IV. Provider business mailing address

2139 AUSTIN AVE
ROCHESTER HILLS MI
48309-3668
US

V. Phone/Fax

Practice location:
  • Phone: 248-794-7135
  • Fax:
Mailing address:
  • Phone: 248-794-7135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK SMITH
Title or Position: OWNER
Credential: ND, BCHHP
Phone: 248-794-7135