Provider Demographics
NPI:1376566034
Name:WOLF, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:JOHN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10024 SKOKIE BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1025
Mailing Address - Country:US
Mailing Address - Phone:847-677-8577
Mailing Address - Fax:847-677-8574
Practice Address - Street 1:240 SAUNDERS RD
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3835
Practice Address - Country:US
Practice Address - Phone:847-236-1701
Practice Address - Fax:847-236-1705
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209431OtherMEDICARE GROUP
IL036087172Medicaid
IL110240081OtherMEDICARE RAILROAD
IL036087172Medicaid