Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 2901600471 | MI |
Y | 213EG0000X | General Practice | 2901600471 | MI |
NPI | 1003425612 |
---|---|
Provider Name | Markus Franz Wolfram |
First Address | Royal Oak, MI 48073-3639 |
Second Address | Grand Blanc, MI 48439-1482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2020 |
Last Update Date | 29/07/2020 |