1427492511 NPI number — ENRIQUE A WULFF MD PA

Table of content: (NPI 1427492511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427492511 NPI number — ENRIQUE A WULFF MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENRIQUE A WULFF MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427492511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
351 NW LEJEUNE RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-5683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-642-4616
Provider Business Mailing Address Fax Number:
305-631-1419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 NW LEJEUNE RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-5683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-642-4616
Provider Business Practice Location Address Fax Number:
305-631-1419
Provider Enumeration Date:
04/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WULFF
Authorized Official First Name:
ENRIQUE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-642-4646

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  ME82397 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 261721800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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