Provider Demographics
NPI:1114030186
Name:WULFF, ENRIQUE A (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:A
Last Name:WULFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 NW LEJEUNE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5683
Mailing Address - Country:US
Mailing Address - Phone:305-642-4616
Mailing Address - Fax:305-631-1419
Practice Address - Street 1:351 NW LEJEUNE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5683
Practice Address - Country:US
Practice Address - Phone:305-642-4616
Practice Address - Fax:305-631-1419
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME823972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261721800Medicaid
H40703Medicare UPIN