Provider Demographics
NPI:1821142126
Name:WOLFE, KRISTAL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAL
Middle Name:ANN
Last Name:WOLFE
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 1:2801 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5727
Mailing Address - Country:US
Mailing Address - Phone:954-727-4713
Mailing Address - Fax:954-727-4712
Practice Address - Street 1:2801 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5727
Practice Address - Country:US
Practice Address - Phone:954-727-4713
Practice Address - Fax:954-727-4712
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0070748207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272856700Medicaid
FL31572XMedicare PIN
FL272856700Medicaid
FL31572ZMedicare ID - Type Unspecified