Provider Demographics
NPI:1356586481
Name:EDWARD WOLPERT MD SC LTD
Entity type:Organization
Organization Name:EDWARD WOLPERT MD SC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:608-588-7173
Mailing Address - Street 1:E7560 TROY VILLAGE RD.
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588
Mailing Address - Country:US
Mailing Address - Phone:608-588-2600
Mailing Address - Fax:608-588-2644
Practice Address - Street 1:156 W JEFFERSON
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588
Practice Address - Country:US
Practice Address - Phone:608-588-2600
Practice Address - Fax:608-588-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002659103TC0700X
IL036373752084P0800X
WI186570202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty