Provider Demographics
NPI:1710995121
Name:WOLF, BERNARD G II (DO)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:G
Last Name:WOLF
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1315 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1400
Mailing Address - Country:US
Mailing Address - Phone:630-896-6565
Mailing Address - Fax:630-896-9735
Practice Address - Street 1:1315 N HIGHLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1400
Practice Address - Country:US
Practice Address - Phone:630-896-6565
Practice Address - Fax:630-896-9735
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36030570207R00000X
IL0360506702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14282Medicare UPIN
646311Medicare ID - Type Unspecified