Provider Demographics
NPI:1417911199
Name:WOLFF, ALLAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:PAUL
Last Name:WOLFF
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 1:3633 W LAKE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5805
Mailing Address - Country:US
Mailing Address - Phone:847-729-9122
Mailing Address - Fax:847-729-9134
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-729-9122
Practice Address - Fax:847-729-9134
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615422OtherBLUE CROSS BLUE SHIELD
604520Medicare ID - Type Unspecified
C38612Medicare UPIN