Provider Demographics
NPI:1740609270
Name:WOLF, ANDREW
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 N LAKEVIEW AVE
Mailing Address - Street 2:APPT 3305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1840
Mailing Address - Country:US
Mailing Address - Phone:312-241-4435
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:SUITE 761 JONES BUILDING RUSH UNIVERSITY MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-13
Last Update Date:2014-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1130000652080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine