Healthcare Provider Details

I. General information

NPI: 1356186787
Provider Name (Legal Business Name): ADVANCED HEALTH CARE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CONSTITUTION DR STE 217
VIRGINIA BEACH VA
23462-6799
US

IV. Provider business mailing address

100 CONSTITUTION DR STE 217
VIRGINIA BEACH VA
23462-6799
US

V. Phone/Fax

Practice location:
  • Phone: 757-963-7729
  • Fax: 757-470-5665
Mailing address:
  • Phone: 559-977-1489
  • Fax: 559-272-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL GEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 559-977-1489