MEDICARE: DR. GARY WOLK DOCKS D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	000785	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558370197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY WOLK DOCKS D.P.M.

Provider Business Mailing Address
First Line	:	18161 W 13 MILE RD
Second Line	:	D-2
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-1113
Country	:	US
Telephone Number	:	248-258-0001
Fax Number	:	248-258-6779

Provider Business Practice Location Address
First Line	:	18810 BEVERLY RD
Second Line	:
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-4014
Country	:	US
Telephone Number	:	248-646-5209
Fax Number	:	248-203-6927

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/28/2009

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