Healthcare Provider Details

I. General information

NPI: 1972562148
Provider Name (Legal Business Name): DAVID M WULFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SHORE DR STE 315
INDIANAPOLIS IN
46254-4693
US

IV. Provider business mailing address

3850 SHORE DR STE 315
INDIANAPOLIS IN
46254-4693
US

V. Phone/Fax

Practice location:
  • Phone: 317-429-0061
  • Fax:
Mailing address:
  • Phone: 317-429-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000305A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: