Provider Demographics
NPI:1427541937
Name:WOLF, JOSEPH RYNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RYNE
Last Name:WOLF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 HARROUN RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2197
Mailing Address - Country:US
Mailing Address - Phone:419-885-4471
Mailing Address - Fax:
Practice Address - Street 1:4913 HARROUN RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2197
Practice Address - Country:US
Practice Address - Phone:419-885-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5951000961213ES0103X
MI5901002729213ES0103X
FLPO4261213ES0103X
OH36.004092213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1427541937Medicaid