Provider Demographics
NPI:1205850096
Name:WOLF, BARTH ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARTH
Middle Name:ALLEN
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 1:1200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1423
Mailing Address - Country:US
Mailing Address - Phone:734-475-1200
Mailing Address - Fax:734-475-9210
Practice Address - Street 1:1200 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-474-1200
Practice Address - Fax:734-475-9210
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001407213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH16200001Medicare ID - Type Unspecified
MIU23425Medicare UPIN