Healthcare Provider Details

I. General information

NPI: 1043214794
Provider Name (Legal Business Name): ANDREA C WOLFE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 SADDLEBACK DR NE
GRAND RAPIDS MI
49525-3493
US

IV. Provider business mailing address

329 SADDLEBACK DR NE
GRAND RAPIDS MI
49525-3493
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-6790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301076695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: