Provider Demographics
NPI:1699949479
Name:DR. WENDY MCKAY P.C. DBA SPRINGWELLS CLINIC
Entity type:Organization
Organization Name:DR. WENDY MCKAY P.C. DBA SPRINGWELLS CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:YOUSIF
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-842-8300
Mailing Address - Street 1:2117 SPRINGWELLS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-1507
Mailing Address - Country:US
Mailing Address - Phone:313-842-1800
Mailing Address - Fax:313-842-0600
Practice Address - Street 1:2117 SPRINGWELLS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-1507
Practice Address - Country:US
Practice Address - Phone:313-842-1800
Practice Address - Fax:313-842-0600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. WENDY MCKAY DBA FAMILY CARE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045701173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB44213Medicare UPIN