Provider Demographics
NPI:1508805284
Name:WOLFORD, MICHAEL GLENN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GLENN
Last Name:WOLFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WATERWAY RD APT 104
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2752
Mailing Address - Country:US
Mailing Address - Phone:561-524-5871
Mailing Address - Fax:561-746-2997
Practice Address - Street 1:200 WATERWAY RD
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2764
Practice Address - Country:US
Practice Address - Phone:561-422-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201564207P00000X
PAOS007470L207P00000X
FLOS9197207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F61569Medicare UPIN