Provider Demographics
NPI:1790332096
Name:PROGRESSIVE WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SETHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-491-3639
Mailing Address - Street 1:1556 E LAFAYETTE ST # 279
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2985
Mailing Address - Country:US
Mailing Address - Phone:202-491-3639
Mailing Address - Fax:
Practice Address - Street 1:5757 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2277
Practice Address - Country:US
Practice Address - Phone:248-633-8576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty