Individual
IRA S. WOLLNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2436
Mailing address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2436
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
042485
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199332610
—
MI
01
—
700H262220
BLUE CROSS-BLUE CROSS
—
01
—
IW042485
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
12/01/2006
Last updated
07/08/2007
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