Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 12010083A | IN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 12010083 | IN |
NPI | 1346221108 |
---|---|
Provider Name | Dr. Paul Louis Wolf |
First Address | Schererville, IN 46375-2656 |
Second Address | Schererville, IN 46375-2656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 26/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000084422 | BC BS PROVIDER PIN NUMBER (01) | IN |
200196800 | (05) | IN |
986521 | UNITED CONCORDIA NUMBER (01) | IN |
P00111143 | RAILROAD MEDICARE NUMBER (01) | IN |
U72567 | (02) | IN |