Wellington Provider Group, PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

WELLINGTON PROVIDER GROUP, PC

Practice address

400 Renaissance Ctr Ste 2200
Detroit, MI 48243-1502

Phone

(859) 439-0400

NPI assigned

Nov 25, 2022

Organization subpart

Yes

Parent organization

WELLINGTON PROVIDER GROUP, PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brittany Dennis

Title

Credentialing Manager

Phone

(859) 518-8817

Specialties & licenses 1

Addresses

Part of

Wellington Provider Group P

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669334400000",
    "number": "1437869922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 WELLINGTON WAY STE 330",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405031331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 RENAISSANCE CTR STE 2200",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482431502",
            "telephone_number": "859-439-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLINGTON PROVIDER GROUP, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLINGTON PROVIDER GROUP, PC",
        "enumeration_date": "2022-11-25",
        "last_updated": "2022-11-25",
        "certification_date": "2022-11-25",
        "status": "A",
        "authorized_official_last_name": "DENNIS",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "859-518-8817"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.