Organization
NUTRIGENOMIC MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MEULENDYK D.O. (OWNER)
(248) 335-3134
Entity
Organization
Contact information
Practice address
19229 MACK AVE, GROSSE POINTE WOODS, MI 48236-2858
(313) 647-3320
Mailing address
1983 KEMP RD, BLOOMFIELD, MI 48302-0142
(248) 335-3134
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
5101007821
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4802974
—
MI
Enumeration date
11/28/2007
Last updated
11/28/2007
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