NPIMap

Organization Active NPI

Seniors Wellness Group of Michigan, P.C.

  • Clinical Psychologist
  • Royal Oak, MI
National Provider Identifier
1801848718
Registry record updated Jul 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301006594 Issued in MI
Legal business name
SENIORS WELLNESS GROUP OF MICHIGAN, P.C.
Practice address
221 S Main St
Suite 201
Royal Oak, MI 48067-2611
Phone
(248) 398-6459
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Authorized official

Name
Dr. Gregory Michael Kotlarz, PH.D.
Title
Owner
Phone
(248) 398-6459

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 6301006594 MI Primary

Addresses

Primary practice location

221 S Main St
Suite 201
Royal Oak, MI 48067-2611

Mailing address

221 S Main St
Suite 201
Royal Oak, MI 48067-2611
Phone (248) 398-6459

National Provider Directory

National Provider Directory

Locations

8750 Monroe Rd
Durand, MI 48429
Phone (989) 288-3166

14041 Pennsylvania Rd
Riverview, MI 48193
Phone (734) 284-7200

Practitioners & affiliated clinicians

Practitioners 80

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1801848718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 S MAIN ST",
            "address_2": "SUITE 201",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480672611",
            "telephone_number": "248-398-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 S MAIN ST",
            "address_2": "SUITE 201",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480672611",
            "telephone_number": "248-398-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIORS WELLNESS GROUP OF MICHIGAN, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A",
        "authorized_official_last_name": "KOTLARZ",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-398-6459",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.