Provider Demographics
NPI:1831407311
Name:HEALTH AND WELLNESS MEDICINE
Entity type:Organization
Organization Name:HEALTH AND WELLNESS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEWERENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-419-5514
Mailing Address - Street 1:30160 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2293
Mailing Address - Country:US
Mailing Address - Phone:248-419-5514
Mailing Address - Fax:248-419-5515
Practice Address - Street 1:30160 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2293
Practice Address - Country:US
Practice Address - Phone:248-419-5514
Practice Address - Fax:248-419-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-18
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty