| Bethesida Wholestic Center Pllc | |
|
21411 Civic Center Dr Ste 102 Southfield MI 48076-3949 | |
| (248) 820-7030 | |
| (248) 499-1235 |
| Full Name | Bethesida Wholestic Center Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 21411 Civic Center Dr Ste 102, Southfield, Michigan |
| Authorized Official Name and Position | Grace W Patterson (PRESIDENT, CEO) |
| Authorized Official Contact | 2488207030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bethesida Wholestic Center Pllc 275 Applewood Ln Bloomfield Township MI 48302-1101 Ph: (248) 820-7030 | Bethesida Wholestic Center Pllc 21411 Civic Center Dr Ste 102 Southfield MI 48076-3949 Ph: (248) 820-7030 |
| NPI Number | 1598980385 |
|---|---|
| Provider Enumeration Date | 04/16/2007 |
| Last Update Date | 08/15/2019 |
| Medicare PECOS PAC ID | 1951408624 |
|---|---|
| Medicare Enrollment ID | O20070515000426 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598980385 | NPI | - | NPPES |
| Provider Name | Grace W Patterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093811200 PECOS PAC ID: 4981604170 Enrollment ID: I20070112000099 |
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