| Revolution Wellness | |
|
51850 Dequindre Rd Ste 2 Shelby Township MI 48316-2806 | |
| (586) 323-0301 | |
| Not Available |
| Full Name | Revolution Wellness |
|---|---|
| Speciality | Internal Medicine |
| Location | 51850 Dequindre Rd Ste 2, Shelby Township, Michigan |
| Authorized Official Name and Position | Chadi Mansour (PHYSICIAN) |
| Authorized Official Contact | 5863230301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revolution Wellness Po Box 3272 Saginaw MI 48605-3272 Ph: (989) 797-1400 | Revolution Wellness 51850 Dequindre Rd Ste 2 Shelby Township MI 48316-2806 Ph: (586) 323-0301 |
| NPI Number | 1073842241 |
|---|---|
| Provider Enumeration Date | 12/16/2009 |
| Last Update Date | 09/17/2021 |
| Medicare PECOS PAC ID | 2668509209 |
|---|---|
| Medicare Enrollment ID | O20100429001019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073842241 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301077635 (Michigan) | Primary |
| Provider Name | Chad H Mansour |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730186594 PECOS PAC ID: 8426087784 Enrollment ID: I20050806000112 |
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