Provider Demographics
NPI:1154571651
Name:ULTIMATE WELLNESS CENTER INC
Entity type:Organization
Organization Name:ULTIMATE WELLNESS CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DORRIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:COCA-SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-477-0112
Mailing Address - Street 1:30852 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2606
Mailing Address - Country:US
Mailing Address - Phone:248-477-0112
Mailing Address - Fax:248-477-9365
Practice Address - Street 1:30852 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2606
Practice Address - Country:US
Practice Address - Phone:248-477-0112
Practice Address - Fax:248-477-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty