Healthcare Provider Details

I. General information

NPI: 1114030186
Provider Name (Legal Business Name): ENRIQUE A WULFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E STATE ST
SALEM OH
44460-2423
US

IV. Provider business mailing address

1995 E STATE ST
SALEM OH
44460-2423
US

V. Phone/Fax

Practice location:
  • Phone: 330-337-4940
  • Fax: 330-337-6947
Mailing address:
  • Phone: 330-337-4940
  • Fax: 330-337-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME82397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: