Provider Demographics
NPI:1770779498
Name:WOLFE, MICHAEL SHAWN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAWN
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:PO BOX 21724
Mailing Address - Street 2:CARE OF USA MEDICAL SERVICES, P.C.
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 ABBEY CREEK CT
Practice Address - Street 2:CARE OF USA MEDICAL SERVICES, P.C.
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2223
Practice Address - Country:US
Practice Address - Phone:877-872-5788
Practice Address - Fax:866-698-7272
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245347208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery