Provider Demographics
NPI:1184763542
Name:WOLFMAN, STEVEN H (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:H
Last Name:WOLFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 WILLOW RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3450
Mailing Address - Country:US
Mailing Address - Phone:224-255-5600
Mailing Address - Fax:224-255-5661
Practice Address - Street 1:1622 WILLOW RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3450
Practice Address - Country:US
Practice Address - Phone:224-255-5600
Practice Address - Fax:224-255-5661
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG59140Medicare UPIN
IL429980Medicare ID - Type Unspecified