MEDICARE: WOLFFALLERGYASTHMA PLLC

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	207RA0201X	Allergy & Immunology (Internal Medicine) Physician

General Provider Information

NPI Number	:	1689333080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOLFFALLERGYASTHMA PLLC

Provider Business Mailing Address
First Line	:	419 CANAL VIEW CIR APT G
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-6139
Country	:	US
Telephone Number	:	313-871-7572
Fax Number	:

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	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GAREN SLAY WOLFF
Credential	:	MD
Telephone Number	:	313-871-7572

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	12/13/2021

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