1821749805 NPI number — WHOLE HEALTH REGENERATIVE MEDICINE, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821749805 NPI number — WHOLE HEALTH REGENERATIVE MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHOLE HEALTH REGENERATIVE MEDICINE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821749805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49685-1447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-943-2100
Provider Business Mailing Address Fax Number:
231-766-6161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3639 CASS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49684-9153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-943-2100
Provider Business Practice Location Address Fax Number:
231-766-6161
Provider Enumeration Date:
01/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MORAN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
231-943-2100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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