Provider Demographics
NPI:1811127376
Name:WOLF, ELLIOTT MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:MICHAEL
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-761-8272
Mailing Address - Fax:248-548-7246
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 600
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-761-8272
Practice Address - Fax:248-548-7246
Is Sole Proprietor?:No
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010301982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry