Provider Demographics
NPI:1831150200
Name:WOLKE, IRA S (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:S
Last Name:WOLKE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 GLENAYRE DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3106
Mailing Address - Country:US
Mailing Address - Phone:312-441-1313
Mailing Address - Fax:
Practice Address - Street 1:930 GLENAYRE DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3106
Practice Address - Country:US
Practice Address - Phone:312-441-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1001832085N0904X, 2085P0229X
PAMD4328312085P0229X, 2085R0202X, 2085N0904X
KY413972085R0202X
IN036.1001832085R0202X
IL036-1001832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831150200OtherNPI
2085R0202XOtherHIPAA TAXONOMY
ILH22969Medicare UPIN
204182631OtherFIN
ILL80111Medicare ID - Type Unspecified