Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07000345B | IN |
Y | 222Z00000X | Podiatrist | 07000345B | IN |
NPI | 1033205950 |
---|---|
Provider Name | Joseph G Wolfe |
First Address | Poplar Grove, IL 61065-8991 |
Second Address | Princeton, IN 47670-1043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000067666 | BLUE CROSS BLUE SHIELD (01) | IN |
T34653 | (02) |