# NUTRIGENOMIC MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295917649
- **Authorized official:** JOHN MEULENDYK D.O. (OWNER)
- **Authorized official phone:** (248) 335-3134

## Contact information

- **Practice address:** 19229 MACK AVE, GROSSE POINTE WOODS, MI 48236-2858
- **Practice address phone:** (313) 647-3320
- **Mailing address:** 1983 KEMP RD, BLOOMFIELD, MI 48302-0142
- **Mailing address phone:** (248) 335-3134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0901X | Public Health & General Preventive Medicine Physician | 5101007821 | MI | Yes |

## Other

- **Enumeration date:** 11/28/2007
- **Last updated:** 11/28/2007