Provider Demographics
NPI:1386810356
Name:JONATHAN P WULFF, D.O., PC
Entity type:Organization
Organization Name:JONATHAN P WULFF, D.O., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WULFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-663-4800
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-0269
Mailing Address - Country:US
Mailing Address - Phone:517-663-4800
Mailing Address - Fax:517-663-5650
Practice Address - Street 1:1501 KYLE ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-8908
Practice Address - Country:US
Practice Address - Phone:517-663-4800
Practice Address - Fax:517-663-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5230011Medicare PIN
MIF00564Medicare UPIN