MEDICARE: THE WELLNESS PLAN MEDICAL CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114420353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WELLNESS PLAN MEDICAL CENTERS

Provider Business Mailing Address
First Line	:	7700 2ND AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2411
Country	:	US
Telephone Number	:	313-202-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	27321 HAMPDEN ST RM 202
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3113
Country	:	US
Telephone Number	:	313-202-8660
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE AND CREDENTIALING
Name	:	SHERRI ATWATER
Credential	:
Telephone Number	:	313-202-8500

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	07/30/2019

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