Healthcare Provider Details

I. General information

NPI: 1851483283
Provider Name (Legal Business Name): JOYCE A WOLF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2877 CROOKS RD
TROY MI
48084-4717
US

IV. Provider business mailing address

1530 BEACON ST APT. #1504
BROOKLINE MA
02446-2630
US

V. Phone/Fax

Practice location:
  • Phone: 248-816-1420
  • Fax:
Mailing address:
  • Phone: 248-816-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32829
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: