Provider Demographics
NPI:1023043973
Name:WOLF, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2055 BLOOMFIELD WOODS CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1915
Mailing Address - Country:US
Mailing Address - Phone:248-454-0888
Mailing Address - Fax:248-332-0451
Practice Address - Street 1:2055 BLOOMFIELD WOODS CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1915
Practice Address - Country:US
Practice Address - Phone:248-454-0888
Practice Address - Fax:248-332-0451
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-07-08
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Provider Licenses
StateLicense IDTaxonomies
MIMW052955207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI352108410Medicaid
MIF04772Medicare UPIN
MI352108410Medicaid