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General NPI Number Information
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NPI Number | 1003805904
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Entity Type | Individual
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Provider Name | ROBERT J WOLF MD
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Gender | Male
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 10/08/2009
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Provider Practice Location Address
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Address Line | 1540 LAKE LANSING RD SUITE 107
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City | LANSING
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State | MI
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Zip | 48912-3756
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Country | US
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Telephone | 517-913-3800
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Fax | 517-913-3901
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Provider Business Mailing Address
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Address Line | 53 HUNTER RD
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City | UXBRIDGE
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State | MA
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Zip | 01569-1153
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Country | US
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Telephone | 508-779-0357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301073351
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License Number State | MI
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