Provider Demographics
NPI:1407973126
Name:DAVID B WOLF MD PC
Entity Type:Organization
Organization Name:DAVID B WOLF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-593-9922
Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4367
Mailing Address - Country:US
Mailing Address - Phone:248-593-9922
Mailing Address - Fax:
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-593-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDW050762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI129454OtherPREFERRED CHOICES
MI1106330171OtherBCBS OF MICHIGAN
MIE49507Medicare UPIN
MI0633017Medicare ID - Type Unspecified
MI129454OtherPREFERRED CHOICES