MEDICARE: WELLSTREET URGENT CARE OF MICHIGAN

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1518740737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSTREET URGENT CARE OF MICHIGAN

Provider Business Mailing Address
First Line	:	1825 HIGHWAY 34 E
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-6423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6470 ORCHARD LAKE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2337
Country	:	US
Telephone Number	:	248-419-8019
Fax Number	:

Authorized Official
Title or Position	:	CGO
Name	:	LEE A RESNICK
Credential	:
Telephone Number	:	216-383-3480

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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