Provider Demographics
NPI:1023033172
Name:WOLFE, STANLEY B (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:B
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37771 SCHOENHERR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2302
Mailing Address - Country:US
Mailing Address - Phone:586-274-2450
Mailing Address - Fax:586-274-2481
Practice Address - Street 1:37771 SCHOENHERR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2302
Practice Address - Country:US
Practice Address - Phone:586-274-2450
Practice Address - Fax:586-274-2481
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISW024812207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4102116Medicaid
MI4102116Medicaid
MIE06345001Medicare ID - Type UnspecifiedCARDIOVASCULAR CONSULTANT
MIM01690020Medicare ID - Type UnspecifiedSECONDARY GROUP PARTICIPA