Provider Demographics
NPI:1467657114
Name:WOLK, NORMAN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:MARTIN
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 1:855 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2712
Mailing Address - Country:US
Mailing Address - Phone:718-642-7953
Mailing Address - Fax:
Practice Address - Street 1:1010 S BIRCH AVE
Practice Address - Street 2:
Practice Address - City:HALLOCK
Practice Address - State:MN
Practice Address - Zip Code:56728-4215
Practice Address - Country:US
Practice Address - Phone:218-843-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25391207Q00000X
MT4711208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C98686Medicare UPIN