Provider Demographics
NPI:1982863478
Name:THE WELLNESS PLAN MEDICAL CENTERS
Entity Type:Organization
Organization Name:THE WELLNESS PLAN MEDICAL CENTERS
Other - Org Name:THE WELLNESS PLAN MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND EXEC. DIR.
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-202-8550
Mailing Address - Street 1:7700 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2477
Mailing Address - Country:US
Mailing Address - Phone:313-202-8660
Mailing Address - Fax:313-202-8653
Practice Address - Street 1:21040 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3025
Practice Address - Country:US
Practice Address - Phone:248-967-6500
Practice Address - Fax:248-967-6528
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WELLNESS PLAN MEDICAL CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231933Medicare Oscar/Certification
MIOM37210Medicare PIN