Provider Demographics
NPI:1912432915
Name:WOHLFERT, TIMOTHY MARCUS-STEPHEN
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MARCUS-STEPHEN
Last Name:WOHLFERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6798 MAYNARD RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875-9688
Mailing Address - Country:US
Mailing Address - Phone:616-902-8748
Mailing Address - Fax:
Practice Address - Street 1:6798 MAYNARD RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875-9688
Practice Address - Country:US
Practice Address - Phone:616-902-8748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer