Provider Demographics
NPI:1124021142
Name:DEWOLFE, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:DEWOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:5400 N OAK TRFY
Practice Address - Street 2:SUITE 101
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4688
Practice Address - Country:US
Practice Address - Phone:816-454-1658
Practice Address - Fax:816-454-1734
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3A25207RH0003X
KS04-19790207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13192OtherCOVENTRY
MO4340992OtherAETNA
MO12440OtherHM CARE
KS2051670901Medicaid
MO201787405Medicaid
MO026295099OtherFEDERAL BLACK LUNG
MO09468014OtherBCBS OF KANSAS CITY
MO1001457701OtherCOMMUNITY HEALTH PLAN
KS497815OtherBCBS OF KANSAS
MO560391OtherFIRSTGUARD
MO3650047OtherUHC
MO480911591028OtherCIGNA
MO97759OtherADVANTRA MEDICARE REPLACE
MO97759OtherADVANTRA MEDICARE REPLACE
MO201787405Medicaid
MO09468014OtherBCBS OF KANSAS CITY
KS497815OtherBCBS OF KANSAS