Provider Demographics
NPI:1366260630
Name:WOLFRAM, UWE ALFRED
Entity type:Individual
Prefix:
First Name:UWE
Middle Name:ALFRED
Last Name:WOLFRAM
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 1:315 BAXTER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2377
Mailing Address - Country:US
Mailing Address - Phone:330-421-3411
Mailing Address - Fax:
Practice Address - Street 1:315 BAXTER ST APT 2
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2377
Practice Address - Country:US
Practice Address - Phone:330-421-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver