Provider Demographics
NPI:1457339046
Name:WOLF, STEVEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:WOLF
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 1:9301 GOLF RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1667
Mailing Address - Country:US
Mailing Address - Phone:847-298-4088
Mailing Address - Fax:847-627-8700
Practice Address - Street 1:9301 GOLF RD
Practice Address - Street 2:SUITE 303
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1667
Practice Address - Country:US
Practice Address - Phone:847-298-4088
Practice Address - Fax:847-627-8700
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL87225Medicare ID - Type UnspecifiedMEDICARE PRIVIDER/PIN #
ILE33476Medicare UPIN