Provider Demographics
NPI:1790878726
Name:WOLF, JUDITH K (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:K
Last Name:WOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:704 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3528
Practice Address - Country:US
Practice Address - Phone:920-338-6868
Practice Address - Fax:920-338-6869
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307831207V00000X
TXH4856207VX0201X
IN01074549A207VX0201X
MN33916207VX0201X
WI71734-20207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01824838OtherMEDICARE RR
IN300001068Medicaid
TX41320501Medicaid
INP01824838OtherMEDICARE RR
AZZ147861Medicare PIN
IN300001068Medicaid