Provider Demographics
NPI:1396288031
Name:WELLNESS MEDICAL P.C. D/B/A SOMERSET REGENERATIVE MEDICINE
Entity type:Organization
Organization Name:WELLNESS MEDICAL P.C. D/B/A SOMERSET REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIUSEPPE
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-362-2300
Mailing Address - Street 1:1080 KIRTS BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4881
Mailing Address - Country:US
Mailing Address - Phone:248-362-2300
Mailing Address - Fax:248-362-5272
Practice Address - Street 1:1080 KIRTS BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4881
Practice Address - Country:US
Practice Address - Phone:248-362-2300
Practice Address - Fax:248-362-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010145132081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty