Provider Demographics
NPI:1013932391
Name:WOLFE, KARL EDWARD (PA-C)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:EDWARD
Last Name:WOLFE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 OLDS ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1128
Mailing Address - Country:US
Mailing Address - Phone:517-849-7100
Mailing Address - Fax:517-849-4056
Practice Address - Street 1:216 OLDS ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1128
Practice Address - Country:US
Practice Address - Phone:517-849-7100
Practice Address - Fax:517-849-4056
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4511135Medicaid
MI5300015OtherBCBS
ON79140Medicare PIN