Provider Demographics
NPI:1659674281
Name:CYRIL WOLF M.D., P.A.
Entity Type:Organization
Organization Name:CYRIL WOLF M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-876-3847
Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:STE 290
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:281-876-3847
Mailing Address - Fax:713-467-7421
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:STE 290
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:281-876-3847
Practice Address - Fax:713-467-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00340JMedicare PIN
TXC23700Medicare UPIN