Provider Demographics
NPI:1003868589
Name:WOLFLA, CHRISTOPHER E (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:E
Last Name:WOLFLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:SPINE CARE CLINIC AT PLANK ROAD
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3462
Mailing Address - Country:US
Mailing Address - Phone:414-805-9255
Mailing Address - Fax:414-955-0110
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:SPINE CARE CLINIC AT PLANK ROAD
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3462
Practice Address - Country:US
Practice Address - Phone:414-805-9255
Practice Address - Fax:414-955-0110
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38469207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000215IOtherHUMANA
WI1003868589Medicaid
G53090Medicare UPIN
WI1003868589Medicaid