Provider Demographics
NPI:1184677825
Name:MOBERG-WOLFF, ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:MOBERG-WOLFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18970 CAVENDISH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-8159
Mailing Address - Country:US
Mailing Address - Phone:262-527-1998
Mailing Address - Fax:866-562-3609
Practice Address - Street 1:3333 N MAYFAIR RD STE 103
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3219
Practice Address - Country:US
Practice Address - Phone:262-527-1998
Practice Address - Fax:866-562-3609
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI324832081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34565400Medicaid
WI34565400Medicaid
G15303Medicare UPIN