| Michigan Institute Of Performance And Health | |
|
43902 Woodward Ave Ste 230 Bloomfield Hills MI 48302-5022 | |
| (248) 481-8428 | |
| (248) 977-5462 |
| Full Name | Michigan Institute Of Performance And Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 43902 Woodward Ave Ste 230, Bloomfield Hills, Michigan |
| Authorized Official Name and Position | Mark S. Wells (OWNER/CLINIC DIRECTOR) |
| Authorized Official Contact | 2484047151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan Institute Of Performance And Health 43902 Woodward Ave Ste 230 Bloomfield Hills MI 48302-5022 Ph: (248) 481-8428 | Michigan Institute Of Performance And Health 43902 Woodward Ave Ste 230 Bloomfield Hills MI 48302-5022 Ph: (248) 481-8428 |
| NPI Number | 1174041321 |
|---|---|
| Provider Enumeration Date | 09/07/2017 |
| Last Update Date | 02/01/2024 |
| Certification Date | 02/01/2024 |
| Medicare PECOS PAC ID | 3779840442 |
|---|---|
| Medicare Enrollment ID | O20171205002478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174041321 | NPI | - | NPPES |
| VC0005376 | Medicaid | MI |
| Provider Name | Renee Harris |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043350895 PECOS PAC ID: 4688861198 Enrollment ID: I20101209001019 |
| Provider Name | Mark S Wells |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154648509 PECOS PAC ID: 8123331246 Enrollment ID: I20150720000466 |
| Provider Name | Edith Root-clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689827768 PECOS PAC ID: 2365863685 Enrollment ID: I20200521003018 |
| Provider Name | Talib Kafaji |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700477924 PECOS PAC ID: 2466868765 Enrollment ID: I20210311001433 |
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