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General NPI Number Information
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NPI Number | 1881389260
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Entity Type | Organization
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Legal Business Name | FULFILLED CARE
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 03/15/2025
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Provider Practice Location Address
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Address Line | 32000 NORTHWESTERN HWY STE 165
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1568
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Country | US
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Telephone | 248-289-8874
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Fax | 351-207-4647
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Provider Business Mailing Address
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Address Line | 32000 NORTHWESTERN HWY STE 165
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1568
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Country | US
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Telephone | 248-289-8874
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Fax | 351-207-4647
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Authorized Official
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Title or Position | OWNER
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Name | JIMMY METELLUS
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Credential | M.D.
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Telephone | 248-289-8874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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