Provider Demographics
NPI:1407510829
Name:WHOLE HEALTH INTEGRATIVE MEDICINE OF MICHIGAN, PLLC
Entity Type:Organization
Organization Name:WHOLE HEALTH INTEGRATIVE MEDICINE OF MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-692-4006
Mailing Address - Street 1:210 W UNIVERSITY DR STE 6
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1975
Mailing Address - Country:US
Mailing Address - Phone:248-692-4006
Mailing Address - Fax:833-974-2235
Practice Address - Street 1:210 W UNIVERSITY DR STE 6
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1975
Practice Address - Country:US
Practice Address - Phone:248-692-4006
Practice Address - Fax:833-974-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty