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General NPI Number Information
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NPI Number | 1235651381
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Entity Type | Organization
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Legal Business Name | THE WELLNESS PLAN MEDICAL CENTERS
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 46156 WOODWARD AVE
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City | PONTIAC
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State | MI
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Zip | 48342-5033
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Country | US
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Telephone | 248-897-0900
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Fax | 248-858-6499
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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 | 48202-2477
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Country | US
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Telephone | 313-202-8660
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Fax | 313-202-8653
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Authorized Official
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Title or Position | CEO & EXECUTIVE DIRECTOR
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Name | 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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