Provider Demographics
NPI:1669410411
Name:WOLFE, PAUL D (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
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 1:1411 W BELLA DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5250
Mailing Address - Country:US
Mailing Address - Phone:765-651-6637
Mailing Address - Fax:765-651-6642
Practice Address - Street 1:1411 W BELLA DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5250
Practice Address - Country:US
Practice Address - Phone:765-651-6637
Practice Address - Fax:765-651-6639
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043039A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200060550Medicaid
ING40389Medicare UPIN
IN231360CMedicare ID - Type Unspecified