Provider Demographics
NPI:1083882948
Name:WOLFE, JOHN WESTON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WESTON
Last Name:WOLFE
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:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:317-567-2180
Mailing Address - Fax:317-713-1261
Practice Address - Street 1:1120 SOUTH DR
Practice Address - Street 2:FESLER HALL RM 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5115
Practice Address - Country:US
Practice Address - Phone:317-274-0275
Practice Address - Fax:317-713-1261
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062027A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200906730Medicaid
IN095200KKKKMedicare PIN