Healthcare Provider Details

I. General information

NPI: 1649264938
Provider Name (Legal Business Name): LYNDA J WOLF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 TOWN CENTER DRIVE SUITE 106
TROY MI
48084-1744
US

IV. Provider business mailing address

130 TOWN CENTER DRIVE SUITE 106
TROY MI
48084-1744
US

V. Phone/Fax

Practice location:
  • Phone: 248-619-3100
  • Fax: 248-619-9031
Mailing address:
  • Phone: 248-619-3100
  • Fax: 248-619-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35070243
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35070243
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number4301056629
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: