Provider Demographics
NPI:1821284407
Name:ASPIRE FAMILY MEDICINE &WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ASPIRE FAMILY MEDICINE &WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-269-9778
Mailing Address - Street 1:850 N MAIN STREET EXT
Mailing Address - Street 2:BLDG 2 SUITE C2
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2400
Mailing Address - Country:US
Mailing Address - Phone:203-269-9778
Mailing Address - Fax:203-949-1544
Practice Address - Street 1:850 N MAIN STREET EXT
Practice Address - Street 2:BLDG 2 SUITE C2
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2400
Practice Address - Country:US
Practice Address - Phone:203-269-9778
Practice Address - Fax:203-949-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty