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 |
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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 |
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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 |
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Provider Enumeration Date | 09/07/2017 |
Last Update Date | 02/01/2024 |
Certification Date | 02/01/2024 |
Medicare PECOS PAC ID | 3779840442 |
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Medicare Enrollment ID | O20171205002478 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174041321 | NPI | - | NPPES |
VC0005376 | Medicaid | MI |
Provider Name | Renee Harris |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1043350895 PECOS PAC ID: 4688861198 Enrollment ID: I20101209001019 |
Provider Name | Mark S Wells |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1154648509 PECOS PAC ID: 8123331246 Enrollment ID: I20150720000466 |
Provider Name | Edith Root-clark |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1689827768 PECOS PAC ID: 2365863685 Enrollment ID: I20200521003018 |
Provider Name | Talib Kafaji |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1700477924 PECOS PAC ID: 2466868765 Enrollment ID: I20210311001433 |
Provider Name | Chad Brynly Cubberly |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1447809843 PECOS PAC ID: 8729428495 Enrollment ID: I20240429000405 |
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