National Provider Identifier Database

MICHIGAN INSTITUTE OF PERFORMANCE AND HEALTH
Multi-Specialty

Contact Information

MICHIGAN INSTITUTE OF PERFORMANCE AND HEALTH
43902 WOODWARD AVE STE 230
BLOOMFIELD HILLS, MI  48302-5022
Phone: 248-481-8428
Fax: 248-977-5462
Website:
Specialty Taxonomy Code
* Multi-Specialty 261QM1300X
Adolescent and Children Mental Health 261QM0855X
Adult Mental Health 261QM0850X
Community Health 261QC1500X
Community/Behavioral Health 251S00000X
Health Service 261QH0100X
Military/U.S. Coast Guard Outpatient 261QM1100X
Substance Abuse Disorder Rehabilitation Facility 324500000X
Substance Abuse Treatment, Children 3245S0500X

* Indicates primary specialty

NPI Profile & details for MICHIGAN INSTITUTE OF PERFORMANCE AND HEALTH

NPI Number 1174041321
Legal business name
LBN		 MICHIGAN INSTITUTE OF PERFORMANCE AND HEALTH
Authorized official MARK WELLS - (OWNER/CLINIC DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 09/07/2017
Last updated 02/01/2024 - About 2 years ago
Sole proprietor1 Not specified
Identifiers
  • MI Medicaid: VC0005376

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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