Provider Demographics
NPI:1205905452
Name:WOLFE, ROBERT ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:BAUDETTE
Mailing Address - State:MN
Mailing Address - Zip Code:56623-2855
Mailing Address - Country:US
Mailing Address - Phone:218-634-1655
Mailing Address - Fax:218-634-1094
Practice Address - Street 1:600 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:BAUDETTE
Practice Address - State:MN
Practice Address - Zip Code:56623-2855
Practice Address - Country:US
Practice Address - Phone:218-634-1655
Practice Address - Fax:218-634-1094
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53272-20207Q00000X
MN43830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807410100Medicaid
IDH41152Medicare UPIN
WI010558005Medicare PIN