| Wellington Provider Group, Pc | |
|
400 Renaissance Ctr Ste 2200 Detroit MI 48243-1502 | |
| (859) 439-0400 | |
| Not Available |
| Full Name | Wellington Provider Group, Pc |
|---|---|
| Speciality | General Practice |
| Location | 400 Renaissance Ctr Ste 2200, Detroit, Michigan |
| Authorized Official Name and Position | Brittany Dennis (CREDENTIALING MANAGER) |
| Authorized Official Contact | 8595188817 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellington Provider Group, Pc 535 Wellington Way Ste 330 Lexington KY 40503-1331 Ph: () - | Wellington Provider Group, Pc 400 Renaissance Ctr Ste 2200 Detroit MI 48243-1502 Ph: (859) 439-0400 |
| NPI Number | 1437869922 |
|---|---|
| Provider Enumeration Date | 11/25/2022 |
| Last Update Date | 11/25/2022 |
| Medicare PECOS PAC ID | 8123412459 |
|---|---|
| Medicare Enrollment ID | O20221221002527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437869922 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Carl Seger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699957308 PECOS PAC ID: 1951455773 Enrollment ID: I20230302001995 |
| Provider Name | Kyle George |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982199519 PECOS PAC ID: 4688909690 Enrollment ID: I20230323002003 |
| Provider Name | Michael Stone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043201262 PECOS PAC ID: 0143275016 Enrollment ID: I20230323002730 |
| Provider Name | Jeremy Stich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295027126 PECOS PAC ID: 7416133616 Enrollment ID: I20230327000997 |
| Provider Name | Julie Foucher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912433756 PECOS PAC ID: 8729355326 Enrollment ID: I20230403000476 |
| Provider Name | Chirag Panchal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437654407 PECOS PAC ID: 1951651868 Enrollment ID: I20230403000665 |
| Provider Name | Jeffrey Graham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609830918 PECOS PAC ID: 5395789507 Enrollment ID: I20230412001051 |
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