Healthcare Provider Details

I. General information

NPI: 1639532120
Provider Name (Legal Business Name): LOTUS WELLNESS CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24423 SOUTHFIELD RD SUITE 100
SOUTHFIELD MI
48075-2864
US

IV. Provider business mailing address

750 S OLD WOODWARD AVE
BIRMINGHAM MI
48009-6600
US

V. Phone/Fax

Practice location:
  • Phone: 248-215-0115
  • Fax: 248-792-6574
Mailing address:
  • Phone: 248-215-0115
  • Fax: 248-792-6574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008133
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501014478
License Number StateMI

VIII. Authorized Official

Name: SILVIO COZZETTO
Title or Position: PRESIDENT
Credential: DC
Phone: 248-792-6570