Healthcare Provider Details

I. General information

NPI: 1407510829
Provider Name (Legal Business Name): WHOLE HEALTH INTEGRATIVE MEDICINE OF MICHIGAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W UNIVERSITY DR STE 6
ROCHESTER MI
48307-1975
US

IV. Provider business mailing address

210 W UNIVERSITY DR STE 6
ROCHESTER MI
48307-1975
US

V. Phone/Fax

Practice location:
  • Phone: 248-692-4006
  • Fax: 833-974-2235
Mailing address:
  • Phone: 248-692-4006
  • Fax: 833-974-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SIMONE COWAN
Title or Position: CO-OWNER
Credential: DO
Phone: 248-692-4006