Provider Demographics
NPI:1740406859
Name:PETER R..WOLFE M.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PETER R..WOLFE M.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:RICE
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-954-1072
Mailing Address - Street 1:5901 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE #401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4667
Mailing Address - Country:US
Mailing Address - Phone:323-954-1072
Mailing Address - Fax:323-954-1081
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:SUITE #401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-954-1072
Practice Address - Fax:323-954-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92467Medicare UPIN