Provider Demographics
NPI:1356876106
Name:MACOMB MEDICAL AND WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:MACOMB MEDICAL AND WELLNESS CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN-LUC
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-393-5439
Mailing Address - Street 1:29135 RYAN RD STE E
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4282
Mailing Address - Country:US
Mailing Address - Phone:248-951-8928
Mailing Address - Fax:248-951-2978
Practice Address - Street 1:29135 RYAN RD STE E
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4282
Practice Address - Country:US
Practice Address - Phone:248-951-8928
Practice Address - Fax:248-951-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care