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NPI Code Detail

MEDICARE: GARY MICHAEL WOLFE II PA-C

MEDICARE: GARY MICHAEL WOLFE II PA-C
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
1363AM0700XMedical Physician Assistant5601005474MI
2363AS0400XSurgical Physician Assistant5601005474MI

General Provider Information

NPI Number : 1598905408
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY MICHAEL WOLFE II PA-C
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number : 947-522-1863
Fax Number :
Provider Business Practice Location Address
First Line : 44201 DEQUINDRE RD
Second Line :
City : TROY
State : MI
Zip : 48085-1117
Country : US
Telephone Number : 248-964-8432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2009
Last Update Date : 06/01/2026

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