Provider Demographics
NPI:1447339460
Name:WOLF, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:STE 230
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4331
Mailing Address - Country:US
Mailing Address - Phone:248-593-9933
Mailing Address - Fax:248-593-5658
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:STE 230
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4331
Practice Address - Country:US
Practice Address - Phone:248-593-9933
Practice Address - Fax:248-593-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDW050762207R00000X
MI4301050762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106330171OtherBCBS OF MI
MI0633017Medicare ID - Type Unspecified
MI1106330171OtherBCBS OF MI