Provider Demographics
NPI:1689666737
Name:WOLF, JOHN J III (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:WOLF
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25651 DETROIT RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2415
Mailing Address - Country:US
Mailing Address - Phone:440-808-8620
Mailing Address - Fax:440-899-4372
Practice Address - Street 1:25651 DETROIT RD
Practice Address - Street 2:SUITE 304
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2415
Practice Address - Country:US
Practice Address - Phone:440-808-8620
Practice Address - Fax:440-899-4372
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34 00 4794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0746385Medicaid
OH110069035OtherRR MEDICARE
OH0896045Medicare PIN
OH0735631Medicare PIN
OH0896041Medicare PIN
OHF53966Medicare UPIN