Provider Demographics
NPI:1881389260
Name:FULFILLED CARE
Entity type:Organization
Organization Name:FULFILLED CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:METELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-289-8874
Mailing Address - Street 1:32000 NORTHWESTERN HWY STE 165
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1568
Mailing Address - Country:US
Mailing Address - Phone:248-289-8874
Mailing Address - Fax:351-207-4647
Practice Address - Street 1:32000 NORTHWESTERN HWY STE 165
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1568
Practice Address - Country:US
Practice Address - Phone:248-289-8874
Practice Address - Fax:351-207-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty