Healthcare Provider Details

I. General information

NPI: 1578048096
Provider Name (Legal Business Name): WELLSTREET URGENT CARE OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ORCHARD LAKE RD STE 100
WEST BLOOMFIELD MI
48322-3424
US

IV. Provider business mailing address

1825 HIGHWAY 34 E STE 1200
NEWNAN GA
30265-6416
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-4134
  • Fax: 248-855-4191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: LEE A. RESNICK
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 404-996-0347