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NPI Code Detail

MEDICARE: TEAM WELLNESS CENTER

MEDICARE: TEAM WELLNESS CENTER
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
12085R0202XDiagnostic Radiology Physician
2261QC1500XCommunity Health Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1588855100
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEAM WELLNESS CENTER
Provider Business Mailing Address
First Line : 290 TOWN CENTER DR STE 400
Second Line :
City : DEARBORN
State : MI
Zip : 48126-2765
Country : US
Telephone Number : 313-274-3700
Fax Number :
Provider Business Practice Location Address
First Line : 2925 RUSSELL ST
Second Line :
City : DETROIT
State : MI
Zip : 48207-4825
Country : US
Telephone Number : 313-396-5300
Fax Number : 313-396-5353
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : ASHLEY NICOLE SEGREST
Credential :
Telephone Number : 313-274-3700
Provider Enumeration Date : 08/08/2007
Last Update Date : 06/03/2026

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Directions to “TEAM WELLNESS CENTER ” Practice Location

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