Healthcare Provider Details

I. General information

NPI: 1891508891
Provider Name (Legal Business Name): WHITE LAKE FAMILY WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9178 HIGHLAND RD STE 1
WHITE LAKE MI
48386-4619
US

IV. Provider business mailing address

9178 HIGHLAND RD STE 1
WHITE LAKE MI
48386-4619
US

V. Phone/Fax

Practice location:
  • Phone: 248-698-1999
  • Fax: 248-698-4446
Mailing address:
  • Phone:
  • Fax:

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 Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAKA CHIPAWE
Title or Position: OWNER
Credential: NP
Phone: 269-277-0952