Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 4301052877 | MI |
NPI | 1083741367 |
---|---|
Provider Name | Dr. Kenneth Wolf |
First Address | Commerce Township, MI 48382-2200 |
Second Address | Commerce Township, MI 48382-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 10/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F98892 | (02) | MI |