Healthcare Provider Details

I. General information

NPI: 1831996115
Provider Name (Legal Business Name): ADVANCED CARE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 S COMMERCE RD
WALLED LAKE MI
48390-3010
US

IV. Provider business mailing address

1340 S COMMERCE RD
WALLED LAKE MI
48390-3010
US

V. Phone/Fax

Practice location:
  • Phone: 248-438-6600
  • Fax: 248-313-9210
Mailing address:
  • Phone: 248-438-6600
  • Fax: 248-313-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MOE WILCOX
Title or Position: MGR
Credential: MGR
Phone: 419-376-5856