Provider Demographics
NPI:1689333080
Name:WOLFFALLERGYASTHMA PLLC
Entity Type:Organization
Organization Name:WOLFFALLERGYASTHMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAREN
Authorized Official - Middle Name:SLAY
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-871-7572
Mailing Address - Street 1:419 CANAL VIEW CIR APT G
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-6139
Mailing Address - Country:US
Mailing Address - Phone:313-871-7572
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty