MEDICARE: GAREN WOLFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301504439	MI

General Provider Information

NPI Number	:	1154855443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAREN WOLFF

Provider Business Mailing Address
First Line	:	3011 W GRAND BLVD STE 210
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3068
Country	:	US
Telephone Number	:	313-871-7572
Fax Number	:	313-789-1714

Provider Business Practice Location Address
First Line	:	3011 W GRAND BLVD STE 210
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3068
Country	:	US
Telephone Number	:	313-871-7572
Fax Number	:	313-789-1714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2017
Last Update Date	:	11/07/2022

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