Provider Demographics
NPI:1215992573
Name:WOLFE, ADAM TROY (DO)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:TROY
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-0260
Practice Address - Street 1:4300 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8328
Practice Address - Country:US
Practice Address - Phone:616-252-1500
Practice Address - Fax:616-252-1599
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101014718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4493340Medicaid
MI0D16078044Medicare PIN
MIN12780006Medicare PIN
MIH79922Medicare UPIN