MEDICARE: STEVEN WOLF, DDS, PC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2901009207	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47679	OTHER	MI	OMNICARE
2	SW009207	OTHER	MI	BCBS LICENSE
3	T82976	OTHER	MI	HAP
4	107503	OTHER	MI	CARE CHOICES
5	U93813	OTHER	MI	HAP
6	4139520	OTHER		AETNA
7	9755066630	OTHER	MI	BCBS
8	147805	OTHER	MI	GREAT LAKES HEALTH PLAN
9	664	OTHER	MI	GREAT LAKE HEALTH PLAN
10	RJ017024	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1801896923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN WOLF, DDS, PC

Provider Business Mailing Address
First Line	:	25916 DEQUINDRE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48091-6112
Country	:	US
Telephone Number	:	586-755-2770
Fax Number	:	586-755-1690

Provider Business Practice Location Address
First Line	:	25916 DEQUINDRE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48091-6112
Country	:	US
Telephone Number	:	586-755-2770
Fax Number	:	586-755-1690

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN MICHAEL WOLF
Credential	:	DDS
Telephone Number	:	586-755-2770

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	04/08/2008

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