Healthcare Provider Details

I. General information

NPI: 1366260630
Provider Name (Legal Business Name): UWE ALFRED WOLFRAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 BAXTER ST APT 2
MEDINA OH
44256-2377
US

IV. Provider business mailing address

315 BAXTER ST APT 2
MEDINA OH
44256-2377
US

V. Phone/Fax

Practice location:
  • Phone: 330-421-3411
  • Fax:
Mailing address:
  • Phone: 330-421-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: