Provider Demographics
NPI:1619940590
Name:WOLF, MELISSA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANNE
Last Name:WOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:AUGUSTYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:905 HIGHLAND BLVD
Mailing Address - Street 2:SUITE 4440
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6901
Mailing Address - Country:US
Mailing Address - Phone:406-556-5150
Mailing Address - Fax:406-556-5155
Practice Address - Street 1:905 HIGHLAND BLVD
Practice Address - Street 2:SUITE 4440
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6901
Practice Address - Country:US
Practice Address - Phone:406-556-5150
Practice Address - Fax:406-556-5155
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11787207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6325Medicaid
UTD6325Medicaid
I39134Medicare UPIN