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General NPI Number Information
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NPI Number | 1992095178
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Entity Type | Organization
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Legal Business Name | HEALTHY WOMEN PLLC
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 1109 W LONG LAKE RD
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City | BLOOMFIELD TOWNSHIP
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State | MI
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Zip | 48302-1967
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Country | US
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Telephone | 248-594-0002
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Fax | 248-594-6236
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Provider Business Mailing Address
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Address Line | 1109 W LONG LAKE RD
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City | BLOOMFIELD TOWNSHIP
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State | MI
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Zip | 48302-1967
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Country | US
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Telephone | 248-594-0002
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Fax | 248-594-6236
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHRISTINE T. WADE
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Credential | M.D.
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Telephone | 248-872-3261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 5315011523
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License Number State | MI
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