MEDICARE: PRIORITY ONE HEALTH ESSENTIALS, PLLC

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	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1649914334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIORITY ONE HEALTH ESSENTIALS, PLLC

Provider Business Mailing Address
First Line	:	20225 ANN ARBOR TRL
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2690
Country	:	US
Telephone Number	:	313-757-7972
Fax Number	:	313-757-7952

Provider Business Practice Location Address
First Line	:	20225 ANN ARBOR TRL
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2690
Country	:	US
Telephone Number	:	313-757-7972
Fax Number	:	313-757-7952

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	FLEETWOOD HARRIS
Credential	:
Telephone Number	:	313-757-7972

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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