Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 4301055822 | MI |
NPI | 1114969714 |
---|---|
Provider Name | Seth W Wolk |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49546-8816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 19/06/2014 |