Provider Demographics
NPI:1699978288
Name:WOLL, DOUGLAS ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:WOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3311 WOODVIEW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3573
Mailing Address - Country:US
Mailing Address - Phone:248-626-0459
Mailing Address - Fax:248-626-0252
Practice Address - Street 1:3311 WOODVIEW LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3573
Practice Address - Country:US
Practice Address - Phone:248-626-0459
Practice Address - Fax:248-626-0252
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine