Healthcare Provider Details

I. General information

NPI: 1760935621
Provider Name (Legal Business Name): NUWELL INTEGRATED HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26454 WOODWARD AVE SUITE B
ROYAL OAK MI
48067-0969
US

IV. Provider business mailing address

390 ENTERPRISE CT STE 103
BLOOMFIELD HILLS MI
48302-0320
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-4000
  • Fax: 248-336-9137
Mailing address:
  • Phone: 248-336-4000
  • Fax: 248-336-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG NAMAN
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 248-336-4000