# FUNDAMENTAL HEALTH, PLLC

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

## Provider details

- **NPI number:** 1699310300
- **Authorized official:** MARISA CLAYSEN (PA-C)
- **Authorized official phone:** (248) 252-2829

## Contact information

- **Practice address:** 725 S ADAMS RD STE 266, BIRMINGHAM, MI 48009-6999
- **Practice address phone:** (248) 252-2829
- **Mailing address:** 1769 BOWERS ST, BIRMINGHAM, MI 48009-6886
- **Mailing address phone:** (248) 252-2829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2019
- **Last updated:** 11/18/2019