Provider Demographics
NPI:1770856387
Name:BERNARD G. WOLF II DO LTD
Entity type:Organization
Organization Name:BERNARD G. WOLF II DO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:630-896-6565
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360506702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD14282Medicare UPIN