Provider Demographics
NPI:1831165372
Name:WOLF, JOCELYN A (MD)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:A
Last Name:WOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:5405 151ST STREET
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224
Practice Address - Country:US
Practice Address - Phone:913-323-8830
Practice Address - Fax:913-323-8831
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-32782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG93000017Medicare PIN
KSI33451Medicare UPIN