Provider Demographics
NPI:1235153818
Name:WOLK, BURRELL HARVEY (MD)
Entity Type:Individual
Prefix:
First Name:BURRELL
Middle Name:HARVEY
Last Name:WOLK
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 1:725 S DOBSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5680
Mailing Address - Country:US
Mailing Address - Phone:480-899-7546
Mailing Address - Fax:480-899-7599
Practice Address - Street 1:725 S DOBSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5680
Practice Address - Country:US
Practice Address - Phone:480-899-7546
Practice Address - Fax:480-899-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10131207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD37868Medicare UPIN
AZZWCLJD01Medicare ID - Type Unspecified