Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS022932L | PA |
Y | 213EG0000X | General Practice | DS022932L | PA |
NPI | 1003898115 |
---|---|
Provider Name | Dr. Michael John Wolff |
First Address | Pittsburgh, PA 15223-2124 |
Second Address | Pittsburgh, PA 15223-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 14/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0858784 | MEDICAL ASSISTANCE (01) | PA |