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General NPI Number Information
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NPI Number | 1841492709
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Entity Type | Organization
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Legal Business Name | CENTER FOR WEIGHT MANAGEMENT
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 13355 E. TEN MILE RD. SUITE CHM
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City | WARREN
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State | MI
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Zip | 48089-2065
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Country | US
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Telephone | 586-759-7457
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Fax |
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Provider Business Mailing Address
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Address Line | 13355 E. TEN MILE RD. SUITE CHM
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City | WARREN
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State | MI
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Zip | 48089-2065
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Country | US
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Telephone | 586-759-7457
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Fax |
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | MS. SALLY JO GREEN
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Credential | R.N., BSN
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Telephone | 586-759-7469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | VS080188
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License Number State | MI
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