Provider Demographics
NPI:1154855443
Name:WOLFF, GAREN
Entity Type:Individual
Prefix:
First Name:GAREN
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 W GRAND BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3068
Mailing Address - Country:US
Mailing Address - Phone:313-871-7572
Mailing Address - Fax:313-789-1714
Practice Address - Street 1:3011 W GRAND BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3068
Practice Address - Country:US
Practice Address - Phone:313-871-7572
Practice Address - Fax:313-789-1714
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301504439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine