Provider Demographics
NPI:1659323756
Name:WULF, DALE G (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:G
Last Name:WULF
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 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0180369123Medicaid
IA27174OtherIOWA HEALTH SOLUTIONS
018394OtherHEALTH ALLIANCE
20979OtherMIDLANDS CHOICE
IA0085191Medicaid
IA0113OtherJOHN DEERE HEALTH
IA20823OtherWELLMARK BC/BS
A00958Medicare UPIN
081043568Medicare PIN
IA20823Medicare PIN