MEDICARE: RISING STAR WELLNESS CENTER PLC

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	207Q00000X	Family Medicine Physician

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	:	1215988845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING STAR WELLNESS CENTER PLC

Provider Business Mailing Address
First Line	:	3189 LOGAN VALLEY RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4772
Country	:	US
Telephone Number	:	231-932-1988
Fax Number	:

Provider Business Practice Location Address
First Line	:	3189 LOGAN VALLEY RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4772
Country	:	US
Telephone Number	:	231-932-1988
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FLORA ERMENIA BIANCALANA
Credential	:	MD
Telephone Number	:	231-932-1988

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	06/14/2013

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