Provider Demographics
NPI:1710681465
Name:MICHIGAN WELLNESS ASSOCIATES PC
Entity Type:Organization
Organization Name:MICHIGAN WELLNESS ASSOCIATES PC
Other - Org Name:MEDI-WEIGHTLOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-775-1700
Mailing Address - Street 1:2019 WASHTENAW AVE UNIT 5403
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3656
Mailing Address - Country:US
Mailing Address - Phone:858-775-1700
Mailing Address - Fax:
Practice Address - Street 1:5816 N SHELDON RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3153
Practice Address - Country:US
Practice Address - Phone:858-775-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty