Provider Demographics
NPI:1124020847
Name:WOLF, ARNOLD BRYAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:BRYAN
Last Name:WOLF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13811 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2705
Mailing Address - Country:US
Mailing Address - Phone:586-247-0840
Mailing Address - Fax:586-247-7668
Practice Address - Street 1:13811 19 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2705
Practice Address - Country:US
Practice Address - Phone:586-247-0840
Practice Address - Fax:586-247-7668
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001164213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480E021060OtherBCBSM
MIP00292814OtherRAILROAD MEDICARE PART B
MI104435OtherGREAT LAKES HEALTH ID
MI870453OtherUNITED HEALTHCARE ID
MI4885050380OtherBCBS ID
MI83069BOtherHAP ID
MI1710645Medicaid
MIAW001164OtherSTATE LICENSE
MI382637930OtherTAX ID
MI4662672OtherAETNA ID
MIC7479OtherM CARE ID
MI4885050380OtherBCBS ID
MIC7479OtherM CARE ID
MI1710645Medicaid
MI0707410001Medicare NSC