Provider Demographics
NPI:1689134926
Name:WOLF, MELANIE NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:NICOLE
Last Name:WOLF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10345 PARKGLENN WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3884
Mailing Address - Country:US
Mailing Address - Phone:847-363-9653
Mailing Address - Fax:
Practice Address - Street 1:10345 PARKGLENN WAY STE 100
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3884
Practice Address - Country:US
Practice Address - Phone:720-851-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0070898207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program