Provider Demographics
NPI:1730253295
Name:THE WHOLE LISTIC YOU PLLC
Entity type:Organization
Organization Name:THE WHOLE LISTIC YOU PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-559-1911
Mailing Address - Street 1:20905 GREENFIELD RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-559-1911
Mailing Address - Fax:248-559-1912
Practice Address - Street 1:20905 GREENFIELD RD
Practice Address - Street 2:SUITE 403
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-559-1911
Practice Address - Fax:248-559-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:2006-12-12
Deactivation Code:
Reactivation Date:2007-05-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4486023Medicaid
MI0N43630Medicare ID - Type Unspecified
F95111Medicare UPIN