Provider Demographics
NPI:1801980701
Name:WOLF, BROOKE M (MD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:M
Last Name:WOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3690 ORANGE PL
Mailing Address - Street 2:SUITE 430
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4464
Mailing Address - Country:US
Mailing Address - Phone:216-464-5330
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL
Practice Address - Street 2:SUITE 430
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4464
Practice Address - Country:US
Practice Address - Phone:216-464-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350399562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD32023Medicare UPIN