Provider Demographics
NPI:1902397334
Name:INTEGRITAS WELLNESS INSTITUTE PLC
Entity Type:Organization
Organization Name:INTEGRITAS WELLNESS INSTITUTE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-953-3780
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:BLOOMFLD HLS
Mailing Address - State:MI
Mailing Address - Zip Code:48303-0829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1639 E BIG BEAVER RD STE 202
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2054
Practice Address - Country:US
Practice Address - Phone:248-606-4190
Practice Address - Fax:248-598-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301096697Medicaid