Provider Demographics
NPI:1497758718
Name:WOLPERT, PAUL W (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:WOLPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:W
Other - Last Name:WOLPERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:612 N SIOUX POINT RD
Mailing Address - Street 2:STE 400
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5088
Mailing Address - Country:US
Mailing Address - Phone:605-232-6353
Mailing Address - Fax:605-232-6500
Practice Address - Street 1:612 N SIOUX POINT RD
Practice Address - Street 2:STE 400
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5088
Practice Address - Country:US
Practice Address - Phone:605-232-6353
Practice Address - Fax:605-232-6500
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3864208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7301600Medicaid
SDCN8257OtherGRP RR MEDICARE
IA0092460Medicaid
SD3864OtherSOUTH DAKOTA LICENSE #
IACP8566OtherGRP RR MEDICARE
SD0003667OtherWELLMARK SOUTH DAKOTA
NE11456OtherNEBRASKA LICENSE NUMBER
IA18017OtherIOWA LICENSE NUMBER
SD3667Medicare ID - Type UnspecifiedSOUTH DAKOTA MEDICARE
SD7301600Medicaid
IACP8566OtherGRP RR MEDICARE
IA09246Medicare ID - Type UnspecifiedIOWA MEDICARE NUMBER