| The Wellness Plan Medical Centers | |
|
2888 W Grand Blvd Detroit MI 48202-2612 | |
| (313) 875-4200 | |
| (313) 875-5611 |
| Full Name | The Wellness Plan Medical Centers |
|---|---|
| Speciality | Clinic/Center |
| Location | 2888 W Grand Blvd, Detroit, Michigan |
| Authorized Official Name and Position | Anthony V. King (CEO AND EXEC DIR) |
| Authorized Official Contact | 3132028550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Wellness Plan Medical Centers 7700 2nd Ave Detroit MI 48202-2477 Ph: (313) 202-8660 | The Wellness Plan Medical Centers 2888 W Grand Blvd Detroit MI 48202-2612 Ph: (313) 875-4200 |
| NPI Number | 1043373244 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 08/13/2020 |
| Medicare PECOS PAC ID | 1052380201 |
|---|---|
| Medicare Enrollment ID | O20040925000098 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043373244 | NPI | - | NPPES |
| 23-1927 | Other | MI | FQHC LOOK A LIKE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Michigan) | Primary |
| Provider Name | Prasani Nilwala Jayatilake |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548211832 PECOS PAC ID: 2668361890 Enrollment ID: I20040317000125 |
| Provider Name | Jacky Duong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780693671 PECOS PAC ID: 3375510159 Enrollment ID: I20040913000025 |
| Provider Name | Rhona Fingal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851478614 PECOS PAC ID: 3870557010 Enrollment ID: I20050215000845 |
| Provider Name | Monica Nicola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477522357 PECOS PAC ID: 1153358239 Enrollment ID: I20050720000537 |
| Provider Name | David Keane Wash |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548211592 PECOS PAC ID: 0648215095 Enrollment ID: I20050919001004 |
| Provider Name | Benjamin J Diaczok |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760480834 PECOS PAC ID: 1355350463 Enrollment ID: I20060419000023 |
| Provider Name | Alireza Amirsadri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457398059 PECOS PAC ID: 4082515564 Enrollment ID: I20060630000137 |
| Provider Name | Linwood W Black |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720123029 PECOS PAC ID: 8426144585 Enrollment ID: I20071019000615 |
| Provider Name | Amitha Kakulavaram |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1720267800 PECOS PAC ID: 2163591173 Enrollment ID: I20080516000464 |
| Provider Name | Hamid Sattar |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1598879496 PECOS PAC ID: 9537237789 Enrollment ID: I20081001000582 |
| Provider Name | Cecilia Cristina Cosma |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992973721 PECOS PAC ID: 5597827469 Enrollment ID: I20081231000255 |
| Provider Name | Deatra L Young |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528187838 PECOS PAC ID: 6901956341 Enrollment ID: I20090605000543 |
| Provider Name | Lameitre C Lockhart |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1053533257 PECOS PAC ID: 9436201670 Enrollment ID: I20090717000601 |
| Provider Name | David Leszkowitz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972546299 PECOS PAC ID: 4789870288 Enrollment ID: I20101123000730 |
| Provider Name | Jenny Phu Shih |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457511040 PECOS PAC ID: 9830386887 Enrollment ID: I20101203000272 |
| Provider Name | Sharon Miller |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619976065 PECOS PAC ID: 6002095130 Enrollment ID: I20110121000482 |
| Provider Name | Tammy L West |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215167739 PECOS PAC ID: 3870740640 Enrollment ID: I20120829000887 |
| Provider Name | Kristi Andrette Sutton Thomas |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1881771749 PECOS PAC ID: 6406007053 Enrollment ID: I20121108000350 |
| Provider Name | Stephen J Warnick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235336991 PECOS PAC ID: 4688827314 Enrollment ID: I20130109000201 |
| Provider Name | Sarah Kironde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316372980 PECOS PAC ID: 5597993733 Enrollment ID: I20140114001229 |
| Provider Name | Christie Y Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780019265 PECOS PAC ID: 7517199409 Enrollment ID: I20140408000553 |
| Provider Name | Adijat Ogunyemi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093051153 PECOS PAC ID: 3375862279 Enrollment ID: I20150427001344 |
| Provider Name | Brittney Rose Daftuar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720405418 PECOS PAC ID: 2860706173 Enrollment ID: I20150730013189 |
| Provider Name | Arash Javanbakht |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1689985699 PECOS PAC ID: 2264749548 Enrollment ID: I20150918001323 |
| Provider Name | Inga Monae Leverett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336526292 PECOS PAC ID: 2365743127 Enrollment ID: I20151221000895 |
| Provider Name | Deirdre Young |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1922291400 PECOS PAC ID: 0446559512 Enrollment ID: I20160425002192 |
| Provider Name | Lemica S Cox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538369301 PECOS PAC ID: 0345539854 Enrollment ID: I20160523000345 |
| Provider Name | Lydia C Ditirro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285950212 PECOS PAC ID: 4688986102 Enrollment ID: I20160711001166 |
| Provider Name | Cheryl E Nickolaou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821466277 PECOS PAC ID: 5496048274 Enrollment ID: I20160802001749 |
| Provider Name | Konwre Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871048470 PECOS PAC ID: 9931488517 Enrollment ID: I20161123000367 |
| Provider Name | Jenay Lisbon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265980023 PECOS PAC ID: 7012299647 Enrollment ID: I20170116000703 |
| Provider Name | Joyce L Wofford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235500570 PECOS PAC ID: 8022307149 Enrollment ID: I20170123000645 |
| Provider Name | Deidre S Alford |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1831235654 PECOS PAC ID: 5193024552 Enrollment ID: I20170310001840 |
| Provider Name | Ebazare Ayewah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083950661 PECOS PAC ID: 7810139813 Enrollment ID: I20170605002301 |
| Provider Name | Katie R Zechar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306070172 PECOS PAC ID: 4587812847 Enrollment ID: I20170718002064 |
| Provider Name | Pritha Chitagi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811316813 PECOS PAC ID: 4385940063 Enrollment ID: I20170726002677 |
| Provider Name | Erinma Ezeugwa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245775683 PECOS PAC ID: 5395017222 Enrollment ID: I20170828000849 |
| Provider Name | Jacita Greve |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972053098 PECOS PAC ID: 8123387222 Enrollment ID: I20180118000527 |
| Provider Name | Danita Dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245741206 PECOS PAC ID: 0446510994 Enrollment ID: I20180201002453 |
| Provider Name | Chaka Chipawe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104378264 PECOS PAC ID: 7618232349 Enrollment ID: I20180530003060 |
| Provider Name | Noureyah Rageh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518479559 PECOS PAC ID: 5193080687 Enrollment ID: I20180605000070 |
| Provider Name | Latanya Cross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396140372 PECOS PAC ID: 0143564658 Enrollment ID: I20181210001575 |
| Provider Name | Chelsea M Covington |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1669033031 PECOS PAC ID: 3173851995 Enrollment ID: I20201229002103 |
| Provider Name | Ashleigh E Singleton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053844795 PECOS PAC ID: 6406260926 Enrollment ID: I20210125001945 |
| Provider Name | Eboni Martin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538505094 PECOS PAC ID: 0840582623 Enrollment ID: I20210126000438 |
Smith Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7800 W Outer Dr, Suite 230, Detroit, MI 48235 Phone: 313-535-0900 Fax: 313-535-3810 | |
St. John Hospital And Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 22101 Moross Rd, Detroit, MI 48236 Phone: 586-753-0011 | |
Community Health And Social Services Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3426 Mack Avenue, Detroit, MI 48207 Phone: 313-849-3920 | |
Health Care Medical Center Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17141 Hayes St, Detroit, MI 48205 Phone: 313-245-1700 Fax: 313-245-1701 | |
Mizrahi Medicine Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7633 E Jefferson Ave Ste 250, Detroit, MI 48214 Phone: 313-821-3338 Fax: 313-823-5363 | |
T L Sea Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 15201 W Mcnichols Rd, Detroit, MI 48235 Phone: 313-516-3142 | |
Community Health And Social Services Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 882 Oakman Blvd, Detroit, MI 48238 Phone: 313-849-3920 Fax: 313-849-0824 |