Provider Demographics
NPI:1265481717
Name:WOLF, DAVID L (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:WOLF
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:3333 BIDDLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-6284
Practice Address - Country:US
Practice Address - Phone:734-324-3667
Practice Address - Fax:734-324-3668
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006786207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24657OtherBLUE CROSS
1457586646OtherGROUP NPI HENRY FORD WYANDOTTE
MI0H24657OtherBLUE CROSS
MIE25778Medicare UPIN
MIPPOMOther382524226
MI382524226OtherBCE EMERGIS
MI512324OtherPREFERRED CHOICES PPO
MI5822803OtherBLUE PREFERRED PLUS
MI1135671OtherFIRST HEALTH
MI5822803OtherBCBC PPO
MI6676861OtherCIGNA
MIP48490OtherBCN
MIQ24567024Medicare PIN
MIE25778Medicare UPIN
MIM84380001Medicare PIN
MI382524226OtherUNITED HEALTHCARE
MI4034223OtherAETNA
MI526422OtherONE HEALTH PLAN GREAT WES
MI1540358-11Medicaid
MI382524226OtherPRIMARY HEALTH SERVICES