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General NPI Number Information
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NPI Number | 1871352583
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Entity Type | Organization
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Legal Business Name | KOLBE HEALTH CLINIC PLLC
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 230 NORTH AVE
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1793
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Country | US
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Telephone | 586-843-7996
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Fax | 217-628-6184
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Provider Business Mailing Address
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Address Line | 230 NORTH AVE
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1793
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Country | US
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Telephone |
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Fax | 217-628-6184
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Authorized Official
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Title or Position | DIRECTOR
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Name | MIKE POLEWSKI
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Credential | PA
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Telephone | 586-843-7996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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