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General NPI Number Information
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NPI Number | 1093180044
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Entity Type | Organization
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Legal Business Name | THE WELLNESS PLAN
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 4909 E OUTER DR
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City | DETROIT
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State | MI
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Zip | 48234-3446
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Country | US
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Telephone | 313-366-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 2ND AVE
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City | DETROIT
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State | MI
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Zip | 48202-2411
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Country | US
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Telephone | 313-202-8660
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Fax |
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Authorized Official
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Title or Position | CEO AND EXECUTIVE DIRECTOR
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Name | MR. ANTHONY V. KING
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Credential |
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Telephone | 313-202-8550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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