Provider Demographics
NPI:1255192712
Name:ELEVATE WELLNESS GROUP
Entity type:Organization
Organization Name:ELEVATE WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-755-8585
Mailing Address - Street 1:1221 BOWERS ST UNIT 170
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-7114
Mailing Address - Country:US
Mailing Address - Phone:248-755-8585
Mailing Address - Fax:
Practice Address - Street 1:1221 BOWERS ST UNIT 170
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48012-7114
Practice Address - Country:US
Practice Address - Phone:248-755-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty