| Seniors Wellness Group, P.c. | |
|
221 S Main St Suite 201 Royal Oak MI 48067-2611 | |
| (248) 398-6459 | |
| Not Available |
| Full Name | Seniors Wellness Group, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 221 S Main St, Royal Oak, Michigan |
| Authorized Official Name and Position | Gregory Michael Kotlarz (OWNER) |
| Authorized Official Contact | 2483986459 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Seniors Wellness Group, P.c. 221 S Main St Suite 201 Royal Oak MI 48067-2611 Ph: (248) 398-6459 | Seniors Wellness Group, P.c. 221 S Main St Suite 201 Royal Oak MI 48067-2611 Ph: (248) 398-6459 |
| NPI Number | 1568419240 |
|---|---|
| Provider Enumeration Date | 05/28/2006 |
| Last Update Date | 07/08/2022 |
| Certification Date | 07/08/2022 |
| Medicare PECOS PAC ID | 1951202357 |
|---|---|
| Medicare Enrollment ID | O20040119000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568419240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Provider Name | Shuja Haque |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427167378 PECOS PAC ID: 9335039817 Enrollment ID: I20040318000230 |
| Provider Name | Hala Salem Pietrangelo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154378172 PECOS PAC ID: 0749260222 Enrollment ID: I20040723001128 |
| Provider Name | Ancuta Elena Matei |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982641544 PECOS PAC ID: 5294790614 Enrollment ID: I20041124000887 |
| Provider Name | Laurel C Bedore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285267039 PECOS PAC ID: 2769802131 Enrollment ID: I20201023001731 |
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