Healthcare Provider Details

I. General information

NPI: 1144757139
Provider Name (Legal Business Name): TIMOTHY WULFESTIEG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER AMC HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER AMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 888-683-2778
  • Fax:
Mailing address:
  • Phone: 888-683-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDOS-1943
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38869
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDO4245
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: